The Association between Cervical Collar and Intracranial Pressure Measured by the Optic Nerve Sheath Diameter in Trauma Patients Refered to the Emergency Department
1Bolu Abant Izzet Baysal University, Medical Faculty Izzet Baysal Training and Research Hospital, Emergency Department, Turkey
DOI: 10.22514/sv.2020.16.0012 Vol.16,Issue 1,June 2020 pp.89-95
Published: 30 June 2020
Objective: The aim of the present study was to determine the effect of the application or prolonged use of a Cervical Collar (CC) on intracranial pressure (ICP) through the changes in optic nerve sheath diameter (ONSD). Materials and methods: This prospective study was performed on 94 adult trauma patients who were referred to the emergency department between November, 15, 2017 and November, 15, 2018. Patients with any co-morbidities were excluded. The following factors were evaluated; age, gender, the mechanism of the trauma, the period between the trauma and admission, presence of any cranial and cervical trauma, symptoms and signs of head trauma, brain tomography (BT) findings, vital parameters, and ONSD values of the patients measured 3 times every 20 minutes. Results: The average age of the patients admitted to the emergency department due to trauma included 51 (54.3%) males and was 42.0 ± 16.1 years. ONSD was 4.8 ± 0.9 mm at admission, 5.0 ± 0.9 mm at the 20th minute of the admission, and was 4.4 ± 0.9 mm at the 20th minute after removal of the CC. The changes in ONSD diameter during the follow-up was statistically significant (p < 0.05). Conclusions: CC increases the ICP and ONSD regardless of the type of trauma types. Unnecessary CC applications should be avoided and the collar should be removed immediately after the presence of cervical trauma has been eliminated.
Cervical collar, Intracranial pressure, Optic nerve sheath diameter, Trauma
Tamer Colak,Kaan Celik. The Association between Cervical Collar and Intracranial Pressure Measured by the Optic Nerve Sheath Diameter in Trauma Patients Refered to the Emergency Department. Signa Vitae. 2020. 16(1);89-95.
 American College of Surgeons (ACS) Committee on Trauma. Advanced trauma life support (ATLS®) Student manual. 9th Ed. American College of Surgeons. 2012:148-205.
 Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J neurotraum. 2014;31:531-40.
 Sparke A, Voss S, Benger J. The measurement of tissue interface pressures and changes in jugular venous parameters associated with cervical immobilisation devices: a systematic review. Scand J Trauma Resus. 2013;21:81.
 Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury. 1996;27:647-9.
 Hunt K, Hallworth S, Smith M. The effects of rigid collar place-ment on intracranial and cerebral perfusion pressures. Anaesthesia. 2001;56:511-3.
 Mobbs RJ, Stoodley MA, Fuller J. Effect of cervical hard collar on intracranial pressure after head injury. ANZ journal of surgery. 2002;72:389-91.
 Gokcen E, Caltekin I, Savrun A, Korkmaz H, Savrun ST, et al. Al-terations in optic nerve sheath diameter according to cerebrovascular disease sub-groups. Am J Emerg Med. 2017;35:1607-11.
 Hansen HC, Lagreze W, Krueger O, Helmke K. Dependence of the optic nerve sheath diameter on acutely applied subarachnoidal pressure - an experimental ultrasound study. Acta ophthalmologica. 2011;89:e528-32.
 Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg. 1997;87:34-40.
 Amini A, Kariman H, Dolatabadi AA, Hatamabadi HR, Derakhshan-far H, et al. Use of the sonographic diameter of optic nerve sheath to estimate intracranial pressure. Am J Emerg Med. 2013;31:236-9.
 Sahoo SS, Agrawal D. Correlation of optic nerve sheath diameter with intracranial pressure monitoring in patients with severe traumatic brain injury. The Indian Journal of Neurotrauma. 2013;10:9-12.
 Hansen HC, Helmke K. The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath. Surg Radiol Anat. 1996;18:323-8.
 Qayyum H, Ramlakhan S. Can ocular ultrasound predict intracranial hypertension? A pilot diagnostic accuracy evaluation in a UK emergency department. Eur J Emerg Med. 2013;20:91-7.
 Frumin E, Schlang J, Wiechmann W, Hata S, Rosen S, et al. Prospective analysis of single operator sonographic optic nerve sheath diameter measurement for diagnosis of elevated intracranial pressure. Western J Emerg Med. 2014;15:217-20.
 Woster CM, Zwank MD, Pasquarella JR, Wewerka SS, Anderson JP, et al. Placement of a cervical collar increases the optic nerve sheath diameter in healthy adults. Am J Emerg Med. 2018;36:430-4.
 Ohle R, McIsaac SM, Woo MY, Perry JJ. Sonography of the Optic Nerve Sheath Diameter for Detection of Raised Intracranial Pressure Compared to Computed Tomography: A Systematic Review and Meta‐analysis. J Ultras Med. 2015;34:1285-94.
 Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med. 2008;15:201-4.
 Stone MB, Tubridy CM, Curran R. The effect of rigid cervical collars on internal jugular vein dimensions. Acad Emerg Med. 2010;17:100-2.
 Karason S, Reynisson K, Sigvaldason K, Sigurdsson GH. Evaluation of clinical efficacy and safety of cervical trauma collars: differences in immobilization, effect on jugular venous pressure and patient comfort. Scand J Trauma Resus. 2014;22:37.
 Raphael J, Chotai R. Effects of the cervical collar on cerebrospinal fluid pressure. Anaesthesia. 1994;49:437-9.
 Kroeker J, Keith J, Carruthers H, Hanna C, Qureshi N, Calic M et al. Investigating the Time‐lapsed Effects of Rigid Cervical Collars on the Dimensions of the Internal Jugular Vein. Clin Anat. 2019;32:196-200.
 Emmez ÖH, Egemen E. Kafa içi basınç artışı tedavisinde pratik yaklaşımlar. Yoğun Bakım Dergisi. 2010;9:77-84.
 Ho AM-H, Fung K, Joynt GM, Karmakar MK, Peng Z. Rigid cervical collar and intracranial pressure of patients with severe head injury. J Trauma Acute Care. 2002;53:1185-8.
Science Citation Index Expanded (SciSearch) The Science Citation Index (SCI) is a citation index originally produced by the Institute for Scientific Information (ISI) and created by Eugene Garfield. It (Science Citation Index Expanded) covers more than 8,500 notable and significant journals, across 150 disciplines in science and technology, from 1900 to the present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.