Cervical Collar in Adult Trauma: Evidence, Controversies, and Clinical Decision-Making

Area of Science:

• Trauma Surgery
• Neurosurgery
• Emergency Medicine

Background:

• Cervical collars are traditionally used routinely in adult trauma to prevent secondary cervical spinal cord injury.
• Emerging evidence supports selective spinal motion restriction and earlier collar removal when instability is ruled out.

Purpose of the Study:

• To evaluate current evidence on the application, avoidance, clearance, and continued use of cervical collars in adult trauma patients.
• To synthesize findings to inform clinical decision-making regarding cervical collar management.

Main Methods:

• A narrative review of current evidence.
• Structured literature search across major biomedical databases and guideline sources.
• Synthesis guided by the Scale for the Assessment of Narrative Review Articles.

Main Results:

• Routine cervical collar use is not generally supported in isolated penetrating trauma and may delay critical management.
• In evaluable patients, validated decision rules and high-quality CT scans support early collar clearance.
• For patients with impaired consciousness, collar removal requires individualized assessment post-negative CT.
• Continued collar use after fracture confirmation should be based on stability, frailty, treatment goals, and tolerance.

Conclusions:

• Cervical collar use in trauma should be selective, based on clinical risk, examination reliability, and phase of care.
• Early collar clearance is appropriate in many cases with negative high-quality imaging.
• Individualized assessment is crucial for collar management in all trauma scenarios, considering potential harms and benefits.