Effect of cervical hard collar on intracranial pressure after head injury

ANZ J Surg. 2002 Jun;72(6):389-91. doi: 10.1046/j.1445-2197.2002.02462.x.


Background: Patients 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.

Methods: A 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.

Results: Nine 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).

Conclusions: Early 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.

MeSH terms

  • Adolescent
  • Adult
  • Braces*
  • Craniocerebral Trauma / physiopathology
  • Craniocerebral Trauma / therapy*
  • Female
  • Humans
  • Intracranial Pressure*
  • Male
  • Middle Aged
  • Neck
  • Prospective Studies