Factors predicting cervical collar-related decubitus ulceration in major trauma patients

Retrospective medical record and electronic database audit to ascertain the incidence and predictors of cervical collar-related decubitus ulceration (CRU).

To determine the incidence and risk factors associated with the development of CRU in major trauma patients immobilized in Philadelphia cervical collars.

Cervical spine immobilization requires the utilization of a cervical collar before spinal clearance, which may be complicated by CRU and increased morbidity.

From a trauma registry database at a level 1 trauma center, 299 major trauma patients admitted over a 6-month period were identified. Predictors of CRU were retrospectively examined and assessed for relative importance using medical records and prospective infection control and radiology databases.

Clinically significant predictors of CRU were ICU admission (P = 0.007), mechanical ventilation (P = 0.005), the necessity for cervical MRI (P < or = 0.001), and time to cervical spine clearance (P < or = 0.001). Time to cervical spine clearance was the major indicator, such that the risk of CRU increased by 66% for every 1 day increase in cervical collar time.

In major trauma patients at a level 1 trauma center, the risk of CRU development increased significantly for every day of Philadelphia cervical collar time. Associated increased morbidity may be reduced by measures aimed at earlier cervical spine clearance.