Pressure sores secondary to immobilization with cervical collar: a complication of acute cervical injury

Cervical collars are essential in the treatment of patients with suspicion or verification of acute cervical spine injury (ACSI). One of the complications of these devices is the development of pressure scores (PS). This study aims to determine its incidence in our unit, the characteristics of patients with ACSI who suffer PS due to the collar and to describe aspects related with these injuries. We include 92 patients with ACSI hospitalized more than 24 hours from January 2002 to December 2003. We analyze demographic variables, incidence, risk factors and characteristics of the PS that develop. The incidence of these lesions was 23.9%. Patients with PS presented: a higher injury severity score (ISS) (37.5 9.8 vs. 31.3 14.9), a greater percentage of catheter carriers of intracraneal pressure (ICP) (55.6% vs. 16.2%), longer time of mechanical ventilation (15.4 8.2 vs. 6.1 9) and longer stays (24.6 10.9 vs. 10 10.3), all statistically significant (p< 0.05). A total of 38 PS were detected, 7 (RI 5-13.8) being the median of the detection day. The chin, occipital and suprascapular zone were the most frequent locations. A total of 42.1% were grade II and 39.5% grade III. The occipital injuries were the most serious and those detected the latest. We conclude that a high index of suspicion of PS due to collar in patients with ACSI, elevated ISS, monitoring of ICP, mechanical ventilation and prolonged stays is required. The occipital zone requires special attention due to the seriousness of the injuries recorded. We suggest a specific multidisciplinary protocol for this problem.