Effect of a cervical collar on optic nerve sheath diameter in trauma patients

doi:10.5847/wjem.j.1920-8642.2024.023

Abstract

Abstract:

BACKGROUND: As advocated in advanced trauma life support and prehospital trauma life support protocols, cervical immobilization is applied until cervical spine injury is excluded. This study aimed to show the difference in optic nerve sheath diameter (ONSD) between patients with and without a cervical collar using computed tomography (CT).

METHODS: This was a single-center, retrospective study examining trauma patients who presented to the emergency department between January 1, 2021, and December 31, 2021. The ONSD on brain CT of the trauma patients was measured and analyzed to determine whether there was a difference between the ONSD with and without the cervical collar.

RESULTS: The study population consisted of 169 patients. On CT imaging of patients with (n=66) and without (n=103) cervical collars, the mean ONSD in the axial plane were 5.43 ± 0.50 mm and 5.04 ± 0.46 mm respectively for the right eye and 5.50 ± 0.52 mm and 5.11 ± 0.46 mm respectively for the left eye. The results revealed an association between the presence of a cervical collar and the mean ONSD, which was statistically significant (P<0.001) for both the right and left eyes.

CONCLUSION: A cervical collar may be associated with increased ONSD. The effect of this increase in the ONSD on clinical outcomes needs to be investigated, and the actual need for cervical collar in the emergency department should be evaluated on a case-by-case basis.

Key words: Optic nerve sheath diameter, Computed tomography, Trauma, Emergency medicine

Mümin Murat Yazici, Özcan Yavaşi̇. Effect of a cervical collar on optic nerve sheath diameter in trauma patients[J]. World Journal of Emergency Medicine, 2024, 15(2): 126-130.

Figures/Tables 5

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References 20

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Variables	All patients (n=169)	Patients wearing cervical collar (n=66)	Patients not wearing cervical collar (n=103)
Gender, n (%) Male Female	112 (66.3) 57 (33.7)	46 (69.7) 20 (30.3)	66 (64.1) 37 (35.9)
Age, year, median (IQR)	40 (25.0-55.0)	38 (25.0-51.0)	42 (25.0-55.5)
GCS, mean±SD	15.0 ± 0.0	15.0 ± 0.0	15.0 ± 0.0
RTS, mean±SD	11.9 ± 0.3	11.9 ± 0.3	12.0 ± 0.2
ISS, mean±SD	0.6 ± 0.7	0.7 ± 0.7	0.6 ± 0.6

Measurements	All patients (n=169)	Patients wearing cervical collar (n=66)	Patients not wearing cervical collar (n=103)	P-value
Right eye ONSD on CT	5.19 ± 0.51	5.43 ± 0.50	5.04 ± 0.46	0.001
Left eye ONSD on CT	5.26 ± 0.52	5.50 ± 0.52	5.11 ± 0.46	0.001

Measurements	Patients wearing cervical collar			Patients not wearing cervical collar
Measurements	Male	Female	P-value	Male	Female	P-value
Right eye ONSD on CT	5.43 ± 0.51	5.43 ± 0.47	0.997	5.16 ± 0.41	4.82 ± 0.49	0.001
Left eye ONSD on CT	5.50 ± 0.53	5.50 ± 0.50	0.992	5.21 ± 0.43	4.92 ± 0.47	0.002

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