Impact of Cervical Collars on Intracranial Pressure Values in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Prospective Studies.
Neurocrit Care
; 32(2): 469-477, 2020 04.
Article
em En
| MEDLINE
| ID: mdl-31190321
BACKGROUND: Spinal cord injury (SCI) is present in around 2-4% of trauma victims. More than half of this injuries are located at the cervical region. Twenty percent of victims with cervical spinal trauma and 5% of patients with severe traumatic brain injury (TBI) will have an SCI. Cervical immobilization with rigid or semirigid collars is routinely used as prophylactic or definitive treatment intervention in general trauma care. An important adverse effect of cervical collars application is the increase in intracranial pressure (ICP) values. This systematic review and meta-analysis aim to estimate the overall magnitude of ICP changes after cervical collar application. METHODS: Major electronic databases (Ovid/Medline, Embase and Cochrane Library) were systematically searched for prospective studies that assessed ICP changes after cervical collar applications. Study level characteristics and ICP values before, during and after cervical collar application, were extracted. The meta-analysis was performed using random-effects model. RESULTS: Five studies comprising 86 patients were included in the systematic review and the quantitative synthesis. The overall increase in ICP after collar application was statistically significant (weighted mean difference [WMD] = 4.43; 95%CI 1.70, 7.17; P < 0.01), meaning an overall ICP increase of approximately 4.4 mmHg. The decrease in ICP values after collar removal reached statistical significance (WMD = - 2.99; 95%CI - 5.45, - 0.52; P = 0.02), meaning an overall ICP decrease of approximately 3 mmHg after collar removal. ICP values before and after cervical collar application were not statistically significant (WMD = 0.49; 95%CI - 1.61, 2.59; P = 0.65), meaning no ICP change. CONCLUSIONS: Heterogeneous studies of application of cervical collars as a partial motion restriction strategy after injuries have demonstrated increases in ICP in TBI patients. Increases in ICP can induce complications in TBI patients. Appropriate selection criteria for cervical motion restriction in TBI patients need to be considered.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Traumatismos da Medula Espinal
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Traumatismos da Coluna Vertebral
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Braquetes
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Pressão Intracraniana
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Vértebras Cervicais
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Lesões Encefálicas Traumáticas
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Imobilização
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
Neurocrit Care
Assunto da revista:
NEUROLOGIA
/
TERAPIA INTENSIVA
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Colômbia
País de publicação:
Estados Unidos