“Cervical Collar Related Pressure Ulcers (CRPU) in Trauma Patients in Intensive Care: Assessment and Prevention of Risks”

Abstract

Abstract

Background Trauma patients (TP) wear a cervical collar (C-collar) to immobilize the cervical spine (C-spine). Development of collar related pressure ulcers (CRPU) is one of the known complications of immobilizing the C-spine. Because risk factors (RF) for the development of CRPU are highly represented in TP admitted to the Intensive Care Unit (ICU), this group of patients are at high risk for developing CRPU. We assessed the prevalence of CRPU, RF and the relationship with preventive interventions. The conceptual framework of DeFloor (1999) was used to explain and organize RF into four concepts: pressure forces, shearing forces, tissue tolerance for pressure and tissue tolerance for oxygen. Methods A descriptive retrospective design was combined with a retrospective case control design. All adult TP wearing a C-collar for > 24 hours, admitted to the ICU in 2006 and 2008, were identified and screened for inclusion. Data were retrospective collected, including patient characteristics, RF and preventive interventions. Results From the 231 TP admitted in the study period, 149 charts were reviewed for inclusion and data was collected for 88 TP Three TP (3.4 %) developed CRPU, located at the occiput and chin. CRPU occurred on day 12, 32 and 36 of admission. In all TP, with or without CRPU, one or more RF were identified. The length in a C-collar appeared to be longer in TP with CRPU (40, 36 and 35 days) versus a mean of 4.6 days for the total group. We were not able to demonstrate a statistical relationship between RF, CRPU and preventive interventions because of insufficient data. Conclusions CRPU in TP within this data set is low. Despite the inability of statistical analysis, descriptive results of this study emphasize the importance of structural preventive care based on reduction of RF. Future research should be guided by a theoretical construction to formulate RF and the effect of preventive interventions.