Pressure ulcers, indentation marks and pain from cervical spine immobilization with extrication collars and headblocks: an observational study

Objectives: To describe the occurrence and severity of pressure ulcers, indentation marks and pain from the extrication collar combined with headblocks. Furthermore, the influence of time, injury severity and patient characteristics on the development of pressure ulcers, indentation marks and pain was explored. Design: ObservationalStudy Setting: Level one trauma center in the NetherlandsParticipants: Adult trauma patients admitted to the Emergency Department in an extrication collar combined with headblocks.Methods: Between January and December 2013, 342 patients were included. Study outcomes were incidence and severity of pressure ulcers, indentation marks and pain. The following dependent variables were collected: time in the cervical collar and headblocks, Glasgow Coma Scale, Mean Arterial Pressure, hemoglobin, Injury Severity Score, gender, age, and Body Mass Index. Results: 75.4% of the patients developed a category 1 and 2.9% a category 2 pressure ulcer. Indentation marks were observed in 221 (64.6%) patients; 96 (28.1%) had severe indentation marks. Pressure ulcers and indentation marks were observed most frequently at the back, shoulders and chest. 63.2% experienced pain, of which, 38.5% experienced severe pain. Pain was mainly located at the occiput. Female patients experienced significantly more pain (NRS >3) compared to male patients (OR=2.14, 95% CI 1.21 - 3.80). None of the investigated variables significantly increased the probability of developing PUs or indentation marks. Conclusions: The high incidence of category 1 pressure ulcers and severe indentation marks indicate an increased risk for pressure ulcer development and may well lead to more severe PU lesions. Pain due to the application of the extrication collar and headblocks may lead to undesirable movement (in order to relieve the pressure) or to bias clinical examination of the cervical spine. It is necessary to revise the current practice of cervical spine immobilization.