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Best evidence topic report
Cervical collars and intracranial pressure
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  1. Muhammad Ahmad,
  2. John Butler
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}man.ac.uk)

http://dx.doi.org/10.1136/emj.18.5.380

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    Report by Muhammad Ahmad; Specialist RegistrarChecked by John Butler Specialist Registrar

    Clinical scenario

    A 26 year old man was brought to the emergency department by the paramedics after a road traffic accident. He was immobilised on a long spinal board and a correctly fitted collar was applied to his neck. The patient was unconscious. You wonder whether the cervical collar raises intracranial pressure in head injury patients

    Three part question

    In [patients with a head injury requiring cervical spine immobilisation] does [a correctly fitted cervical collar] increase [intracranial pressure]?

    Search strategy

    Medline 1966–07/2001 using the OVID interface. [({exp neck OR exp neck injuries OR exp cervical vertebrae OR cervical.mp} AND {exp braces OR brace$.mp OR collar$.mp}) OR cervical collar$.mp) AND {exp intracranial pressure OR intracranial pressure$.mp OR ICP.mp}]

    Search outcome

    Altogether seven papers were found of which four were relevant to the three part question. These four papers are shown in table 6.

    View this table:
    Table 6

    Comments

    These studies have shown that a semi-rigid cervical collar, causes a variable rise in intracranial pressure in most patients.

    Clinical bottom line

    Correctly fitted cervical collars increase intracranial pressure.

    Report by Muhammad Ahmad; Specialist RegistrarChecked by John Butler Specialist Registrar

    References

    1. Craig GR, Nielsen MS. Rigid cervical collars and intracranial pressure. Int Care Med1991;17:504–5.
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    2. Raphael JH, Chotai R. Effects of the cervical collar on cerebrospinal fluid pressure. Anaesthesia1994;49:437–9.
      OpenUrlPubMedWeb of Science
    3. Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury1996;27:647–9.
      OpenUrlCrossRefPubMedWeb of Science
    4. Kolb JC, Summers RL, Galli RL. Cervical collar induced changes in intracranial pressure. Am J Emerg Med1999;17:135–7.
      OpenUrlCrossRefPubMedWeb of Science