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Investigating the effects of cervical collar design and fit on the biomechanical and biomarker reaction at the skin

Authors Worsley PR, Stanger ND, Horrell AK, Bader DL

Received 18 August 2017

Accepted for publication 15 November 2017

Published 15 March 2018 Volume 2018:11 Pages 87—94


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Peter R Worsley, Nathan D Stanger, Aran K Horrell, Dan L Bader

Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK

Background: Research has shown that up to 33% of pressure ulcers (PUs) acquired in hospitals result from the application of a medical device. Cervical collars (C-collars) have been impli-cated in causing PUs, due to the mechanical force they apply to the skin. In order to improve our understanding of collar-related PUs, the present study aimed to assess the biomechanical, biochemical, and microclimate effects of C-collar design and fitting tension.
Methods: A cohort of 15 healthy volunteers was fit with two different C-collars according to the manufacturer guidelines. Two further collar tensions were also defined as loose and tight for each device. Each collar condition was applied for 15 minutes, with a 10 minute refractory period. Measurements at the device–skin interface included interface pressures, inflammatory biomarkers, microclimate, range of cervical motion, and comfort scores.
Results: The interface pressures at each tissue site increased monotonically with greater collar tension (p<0.01), irrespective of collar design. Biomarker analysis revealed that inflammatory cytokines (IL-1a) were elevated during collar application, with the highest increase during the tight fit condition, representing over a fourfold increase from unloaded conditions. Regardless of collar tension or type, there was an increase in temperature 1.5°C ±0.8°C compared to baseline values. Range of motion significantly decreased with greater strap tension (p<0.05), with an associated increase in discomfort.
Conclusion: The present findings revealed that increasing C-collar tensions caused elevated contact pressures at the device–skin interface, with a corresponding inflammatory response at the skin. These peak contact pressures were highest at the occiput, corresponding with reported PU locations. Devices should be designed to uniformly distribute pressures, and appropriate guidance is needed for their application.

Keywords: cervical collar, pressure ulcer, device design, biomechanics, biomarkers

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