Clinical Characteristics of Pediatric Patients With Cervical Collar-Related Pressure Injuries

Hospitalized patients with critical illness have a heightened risk of pressure injury, yet demographic and clinical risk factors for cervical collar-related pressure injuries (CCRPIs) in pediatric trauma patients have not been well described.

This study aims to describe the incidence, timing, and clinical characteristics of CCRPIs in pediatric trauma patients.

This single-center, retrospective cohort study examined all pediatric trauma patients (<18 years) with CCRPI at a Level I Pediatric Trauma Center in the Intermountain West, Western United States, from 2017 to 2024. Demographic and clinical characteristics were analyzed using descriptive statistics.

Twenty CCRPIs were identified in 15 patients over the 8-year study period. The mean patient age was 7 years (range, 7 months-15 years). Most patients required admission to the pediatric intensive care unit (PICU) (86%), mechanical ventilation (93%), sedation (100%), and vasopressor support (60%). Cervical collars remained in place for a mean of 13 days (SD = 13; range, 2-58 days), with CCRPIs identified on hospital day 9 (SD = 6; range, 1-25 days). Injuries occurred on the occiput (35%), chin (35%), and shoulder (15%). Magnetic resonance imaging was performed in 87% of patients on hospital day 5 (SD = 3; range, 1-11 days).

Pediatric patients with CCRPI are characterized by those requiring PICU admission for acute illness, mechanical ventilation, sedation, vasopressor support, and intracranial monitoring. The majority of pediatric patients with CCRPI were placed in cervical collars prophylactically for an extended time. This study highlights that cervical collars are a medical intervention that necessitates a thoughtful risk-benefit analysis.