From the Guidelines
The use of a cervical orthosis (cervical collar) is not recommended for patients with a cervical spine injury due to the potential harms of increased intracranial pressure and the consequences of unnecessary neck movement. This recommendation is based on the most recent and highest quality study available, which suggests that the potential benefits of applying a cervical collar do not outweigh the harms 1. The study highlights that the application of a cervical collar requires training and regular practice to be performed properly, and such training may not be a component of every first aid course curriculum.
Key Points to Consider
- The evidence from available studies, including a 2015 international consensus on first aid science with treatment recommendations, suggests that the use of a cervical collar may increase intracranial pressure and cause further injury 1.
- The studies evaluated the critical outcomes of neurologic injury, complications, and patient comfort, and found that the use of a cervical collar did not provide significant benefits and may even cause harm.
- The task force discussion included the recognition that first aid providers might not be able to discriminate between high- or low-risk individuals, and that manual stabilization may be a better option in certain circumstances 1.
Clinical Implications
- Manual stabilization is recommended instead of cervical collar application for patients with a cervical spine injury, as it may reduce the risk of further injury and increase intracranial pressure.
- Healthcare professionals should be aware of the potential harms of cervical collar application and consider alternative methods for stabilizing the cervical spine.
- Further research is needed to evaluate the effectiveness and safety of cervical collar application in patients with cervical spine injuries.
From the Research
Indications for Cervical Orthosis
The indication for a cervical orthosis (cervical collar) in a patient with a cervical spine injury is to provide immobilization and support to the neck, preventing further injury or exacerbation of the existing condition 2, 3, 4, 5, 6.
Types of Cervical Collars
There are different types of cervical collars, including rigid, semi-rigid, and soft collars. The choice of collar depends on the specific needs of the patient and the severity of the injury.
- Rigid collars are traditionally used for immobilization, but they have been associated with complications such as skin ulcers and infections 5, 6.
- Soft collars, on the other hand, have been shown to be well-tolerated and effective in managing acute cervical spine injury, with no adverse events reported in some studies 2, 3.
- Semi-rigid collars are also used, but there is limited evidence on their effectiveness and safety.
Patient Outcomes
Studies have shown that patients who wear soft collars for acute cervical spine injury management report good adherence to recommendations for use and consider the collars supportive and well-tolerated 2, 4.
- Patient-oriented adverse events, such as discomfort and agitation, are lower in patients who wear soft collars compared to those who wear rigid collars 4.
- There is no significant difference in the rate of adverse neurological events between patients who wear soft collars and those who wear rigid collars 3, 4.
Nursing Management
Nursing care implications for patients who wear cervical collars include monitoring for skin ulcers and infections, providing hygiene and transfer techniques, and educating patients on the proper use and care of the collar 6.
- Further research is needed to quantitatively investigate the patient care outcomes associated with specific interventions and to determine the safety and efficacy of different types of cervical collars.