An evaluation of the effects of semirigid cervical collars in patients with severe closed head injury.

The use of a semirigid cervical collar has been recommended to prevent further cervical spine injury in the management of trauma patients. These cervical collars are kept on obtunded patients for prolonged periods. We assessed the incidence of cervical collar related decubiti in patients with severe closed head injury (SCHI). We also assessed the utility of fluoroscopy in clearing the cervical spine of patients with SCHI. A retrospective chart review was performed on 52 consecutive patients with SCHI at a community hospital-based Level II trauma center over an 8-month period. Thirteen of 34 patients (38%) who survived >24 hours after admission developed decubiti related to the cervical collar. The patients who developed decubiti had a significantly greater duration of cervical collar placement (21.15 +/- 0.99 days) as compared with patients who did not develop decubiti (4.42 +/- 0.79 days; P = 0.001). Eight patients had their cervical spine assessed for ligamentous injury by bedside fluoroscopy. All eight patients had early collar removal; none of these patients developed decubiti. Patients with SCHI with semirigid cervical collars kept in place for prolonged periods of time are at risk for developing decubiti. Fluoroscopy in addition to standard radiographs may "clear" the cervical spine and allow early removal of these collars.