Ann N. Tescher, RN, PhD, CNS; Aaron B. Rindflesch, PT, PhD; James W. Youdas, PT; Therese M. Jacobson, RN, CNS; Lisa L. Downer, RN, CNS; Anne G. Miers, RN, CNS; Jeffrey R. Basford, MD, PhD; Daniel C. Cullinane, MD; Susanna R. Stevens, MS; V Shane Pankratz, PhD; Paul A. Decker, MS
Journal of Trauma-Injury Infection & Critical Care: November 2007 - Volume 63 - Issue 5 - pp 1120-1126
Background: Occipital pressure ulcers are well-known complications for trauma patients wearing cervical collars. We assessed the effects of four commercial cervical collars (Aspen, Philadelphia, Miami J, and Miami J with Occian back [Miami J/Occian]) on cervical range of motion (CROM) and mandibular and occipital tissue-interface pressure (TIP).
Methods: Forty-eight healthy volunteers (24 men, 24 women; mean age, 38.9 years +/- 10.5 years) were stratified by body mass index. CROM was measured in the seated position without and with collars. Sagittal, coronal, and rotatory CROM was measured with a goniometer. Occipital and mandibular pressures were mapped with subjects in upright and supine positions.
Results: All collars significantly restricted CROM in all planes (p < 0.001). The Philadelphia and standard Miami J collars were the most restrictive. The Aspen collar was the least restrictive for flexion and rotation. The Miami J/Occian back was the least restrictive for extension and lateral flexion. For supine measurements, Miami J and Miami J/Occian back had the lowest mean TIP, whereas Aspen and Philadelphia collars had the greatest (p < 0.001). For upright measurements, the Miami J/Occian back produced the smallest mean TIPs; the other collars, ranked by ascending TIP, were Philadelphia, Miami J, and Aspen (p < 0.001). Philadelphia and Miami J collars had significant collar-body mass index interaction effects on supine occiput mean pressure (p = 0.04).
Conclusions: Miami J and Philadelphia collars restricted CROM to the greatest extent. Miami J and Miami J/Occian back had the lowest levels of mandibular and occipital pressure; these collars may markedly reduce the risk of occipital pressure ulcers without compromising immobilization.
(C) 2007 Lippincott Williams & Wilkins, Inc.
Therese M. Jacobson, MSN, CNS, CWOCN; Ann N. Tescher, PhD, RN, CCRN, CCNS; Anne G. Miers, MSN, CNS, CNRN; Lisa Downer, MSN, CNS
St. Mary’s Hospital,Mayo Clinic Rochester, Minnesota. Published in Journal of Nursing Care Quality, 2008 Vol. 23, No. 3, pp. 283–288
Cervical collars are necessary to stabilize the cervical spine of trauma patients but are known to contribute to the development of occipital pressure ulcers. A quality improvement project that began on one nursing unit stimulated the development of evidence-based practice guidelines and a multidisciplinary research study. As a result, a standardized plan of care and cervical collar recommendations were implemented, resulting in a sharp decline in the incidence of occipital pressure ulcers.
Results: “On the basis of the study’s findings, it was recommended that the Miami J collar be used as the standard cervical collar for trauma patients and that the Occian Back of the Miami J collar be used when patients were on strict spine precautions or bed-rest. Implementation occurred during first quarter of 2006 and resulted in an 89% reduction in the incidence of occipital pressure sores in 2006 as compared to 2005”. (p. 287)
In independent university testing, the Sorbatex Miami J Collar pads outperformed the leading competitive cotton/foam laminated pad.
Information from Grundy Laboratory Report: “Comparison Study of Miami J Collar Pads with Cotton/Foam Collar Pads,” Philadelphia College of Textiles & Science, 1997.