Pressure ulcers from spinal immobilization in trauma patients: a systematic review
Pressure ulcers from spinal immobilization in trauma patients: a systematic review
BACKGROUND: To protect the (possibly) injured spine, trauma patients are immobilized on backboard or vacuum mattress, with a cervical collar, lateral headblocks, and straps. Several studies identified pressure ulcer (PU) development from these devices. The aim of this literature study was to gain insight into the occurrence and development of PUs, the risk factors, and the possible interventions to prevent PUs related to spinal immobilization with devices in adult trauma patients.
METHODS: We systematically searched PubMed (MEDLINE), EMBASE, Cochrane, and CINAHL for the period 1970 to September 2011. Studies were included if participants were healthy volunteers under spinal immobilization or trauma patients under spinal immobilization until spine injuries were diagnosed or excluded. Outcomes of primary interest included occurrence, severity, and risk for PU development as well as prevention of PU development related to spinal immobilization devices.
RESULTS: The results of included studies show an incidence of collar-related PUs ranging from 6.8% to 38%. Described locations are the occiput, chin, shoulders, and back. The severity of these PUs varies between Stages 1 and 3, and one study describes PUs requiring surgical debridement, indicating a Stage 4 PU. Described risk factors for PU development are high pressure and pain from immobilizing devices, the length of time in/on a device, intensive care unit admission, high Injury Severity Scores (ISSs), mechanical ventilation, and intracranial pressure monitoring. Preventive interventions for collar-related PUs include early replacement of the extrication collar and regular skin assessment, collar refit, and position change.
CONCLUSION: The results from this systematic review show that immobilization with devices increases the risk for PU development. This risk is demonstrated in nine experimental studies with healthy volunteers and in four clinical studies.
trauma patients, spinal immobilization, cervical collar, backboard, pressure ulcers
1131-1141
Ham, Wietske
5a2b6d7b-3955-42ac-8131-4f6bcf105ea5
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Schuurmans, Marieke J.
cb79c749-bd9b-4881-b485-695c2ba30d00
Leenen, Luke P.H.
8ea469c4-cf76-4ee4-9624-ed1e080c8f2a
April 2014
Ham, Wietske
5a2b6d7b-3955-42ac-8131-4f6bcf105ea5
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Schuurmans, Marieke J.
cb79c749-bd9b-4881-b485-695c2ba30d00
Leenen, Luke P.H.
8ea469c4-cf76-4ee4-9624-ed1e080c8f2a
Ham, Wietske, Schoonhoven, Lisette, Schuurmans, Marieke J. and Leenen, Luke P.H.
(2014)
Pressure ulcers from spinal immobilization in trauma patients: a systematic review.
The Journal of Trauma and Acute Care Surgery, 76 (4), .
(doi:10.1097/TA.0000000000000153).
(PMID:24662882)
Abstract
BACKGROUND: To protect the (possibly) injured spine, trauma patients are immobilized on backboard or vacuum mattress, with a cervical collar, lateral headblocks, and straps. Several studies identified pressure ulcer (PU) development from these devices. The aim of this literature study was to gain insight into the occurrence and development of PUs, the risk factors, and the possible interventions to prevent PUs related to spinal immobilization with devices in adult trauma patients.
METHODS: We systematically searched PubMed (MEDLINE), EMBASE, Cochrane, and CINAHL for the period 1970 to September 2011. Studies were included if participants were healthy volunteers under spinal immobilization or trauma patients under spinal immobilization until spine injuries were diagnosed or excluded. Outcomes of primary interest included occurrence, severity, and risk for PU development as well as prevention of PU development related to spinal immobilization devices.
RESULTS: The results of included studies show an incidence of collar-related PUs ranging from 6.8% to 38%. Described locations are the occiput, chin, shoulders, and back. The severity of these PUs varies between Stages 1 and 3, and one study describes PUs requiring surgical debridement, indicating a Stage 4 PU. Described risk factors for PU development are high pressure and pain from immobilizing devices, the length of time in/on a device, intensive care unit admission, high Injury Severity Scores (ISSs), mechanical ventilation, and intracranial pressure monitoring. Preventive interventions for collar-related PUs include early replacement of the extrication collar and regular skin assessment, collar refit, and position change.
CONCLUSION: The results from this systematic review show that immobilization with devices increases the risk for PU development. This risk is demonstrated in nine experimental studies with healthy volunteers and in four clinical studies.
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Published date: April 2014
Keywords:
trauma patients, spinal immobilization, cervical collar, backboard, pressure ulcers
Organisations:
Faculty of Health Sciences
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Local EPrints ID: 386288
URI: http://eprints.soton.ac.uk/id/eprint/386288
ISSN: 2163-0755
PURE UUID: f2fca0eb-f702-49de-9f9b-e45130df4ce1
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Date deposited: 29 Jan 2016 14:56
Last modified: 15 Mar 2024 03:41
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Contributors
Author:
Wietske Ham
Author:
Marieke J. Schuurmans
Author:
Luke P.H. Leenen
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