The impact of a cervical collar in traumatic brain injury patients in prehospital settings: a systematic review

Abstract

Abstract Purpose: Although the use of a cervical collar in a prehospital setting is recommended to prevent secondary spinal cord injuries and ensure spinal immobilization, it is not known what effects this has on TBI patients. The aim of this study was to systematically review the data related to intracranial pressure (ICP) changes after TBI and analyze the efficacy of using a cervical collar in patients with TBI in a prehospital setting. Methods: We searched Medline (PubMed), Embase, CINAHL and Google Scholar for studies that investigated the use of a spinal collar in the prehospital setting in TBI patients. Titles, abstracts and full texts were then searched for inclusion in the study. A narrative synthesis as well as a meta-analysis was performed. Bias in the included studies was evaluated using the Newcastle-Ottawa scale. Results: Of the 1006 studies identified, only three met the inclusion/exclusion criteria. The quality of all of the included studies was moderate and the risk of bias in the included studies was low. All three studies used the Laerdal Stifneck collar but all studies showed an increase in ICP after application of the collar. A meta-analysis of the pooled data also confirmed a significant increase in ICP. Conclusion: All the studies identified in this systematic review disputed the use of cervical collars in a prehospital setting for patients with TBI. They reported that use of the cervical collars increased the ICP, which led to other complications. Further high-quality research is necessary to unequivocally clarify whether cervical collars should not be used in patients with TBIs and identify appropriate alternative equipment that promotes patients' stability and well- being.