• Ralph J Mobbs, Marcus A Stoodley, and John Fuller.
• Department of Neurosurgery, Institute of Neurological Sciences, The Prince of Wales Hospital, Sydney, New South Wales, Australia. ralphmobbs@hotmail.com
• ANZ J Surg. 2002 Jun 1;72(6):389-91.

BackgroundPatients suffering head trauma are at high risk of having a concomitant cervical spine injury. A rigid cervical collar is usually applied to each patient until spinal stability is confirmed. Hard collars potentially cause venous outflow obstruction and are a nociceptive stimulus, which might elevate intracranial pressure (ICP). This study tested the hypothesis that application of a hard collar is associated with an increase in ICP.MethodsA prospective series of 10 head-injured patients with a postresuscitation Glasgow coma scale score of nine or less had ICP measurements before and after cervical hard collar application.ResultsNine out of 10 patients had a rise in ICP following application of the collar. The difference in pre- and postapplication ICP was statistically significant (P < 0.05).ConclusionsEarly assessment of the cervical spine in head-injured patients is recommended to minimize the risk of intracranial hypertension related to prolonged cervical spine immobilization with a hard collar.

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