Background: Head trauma may cause an increase in intracranial pressure (ICP). The use of ocular ultrasound to measure optic nerve sheath diameter (ONSD) is a method to determine the ICP. The use of the rigid cervical collar in head trauma patients contribute to elevating ICP, and therefore, potentially causing further deterioration in their condition.
Objectives: This study aimed to describe changes in ONSD after the placement of a c-collar and analyze these changes depending on the time in the c-collar.
Methods: This prospective study measured the ONSD of minor head trauma patients before and after the placement of a c-collar. Patients aged ³18 with blunt head trauma and Glasgow Coma Score ³13 were included in the study. Each eye was scanned twice. This was done before c-collar placement, at 5 and 20 min after placement. The mean values of both eyes were calculated and analyzed.
Results: This study investigated 50 patients. The mean baseline ONSD was obtained at 4.71mm±0.22 (4.54-4.77). Furthermore, T5 and T20 measurements were 5.19±0.41 (5.07-5.31) and 5.26±0.45 (5.14-5.39), respectively. The ONSD increased at T5 and T20. The changes from the baseline measurements were statistically significant (P=0.000, P=0.000). The difference between T5 and T20 groups was an increase in ONSD, and these differences were also statistically significant (0.07±0.19; P=0.008).
Conclusion: Our results revealed that minor head trauma patients using a c-collar may increase ONSD by timeline the clinical effects of which have to be determined with further studies. Enlargement in ONSD should be considered when interpreting ICP.
Jarwani B, Shah A. Evaluatıon of optıc nerve sheath dıameter measurement and optıc fundı examınatıon Done ın Ed To Determıne the raısed ıntracranıal pressure ın adults ın acute trauma settıng. J Evol Med Dent Sci. 2013;2(10):1408-13.
The brain trauma foundation. The American Association of Neurological Surgeons. the joint section on neurotrauma and critical care. use of mannitol. J Neurotrauma. 2000;17(6-7):521-5. doı: 10.1089/neu.2000.17.521. [PubMed: 10937895].
Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med. 2003;10(4):376-81. doi: 10.1111/j.1553-2712.2003.tb01352.x. [PubMed: 12670853].
Hayreh SS. Optic disc edema in raised intracranial pressure.V. Pathogenesis. Arch Ophthalmol. 1977;95(9):1553-65. doi: 10.1001/archopht.1977.04450090075006. [PubMed: 71138].
Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med. 2007;49(4):508-14. doi: 10.1016/j.annemergmed.2006.06.040. [PubMed: 16997419].
Zeiler FA, Unger B, Kramer AH, Kirkpatrick AW, Gillman ML. A unique model for ultrasound assessment of optic nerve sheath diameter. Can J Neurol Sci. 2013;40(2):225-9. doi: 10.1017/s0317167100013779. [PubMed: 23419572].
Hansen H-C, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg. 1997;87(1):34-40. doi: 10.3171/jns.1997.87.1.0034. [PubMed: 9202262].
Woster CM, Zwank MD, Pasquarella JR, Wewerka SS, Anderson JP, Greupner JT et al. Placement of a cervical collar increases the optic nerve sheath diameter in healthy adults. Am J Emerg Med. 2018;36(3):430-4. doi: 10.1016/j.ajem.2017.08.051. [PubMed: 28865838].
Kolb JC, Summers RL, Galli RL. Cervical collar-induced changes in intracranial pressure. Am J Emerg Med. 1999;17(2):135-7. doi: 10.1016/s0735-6757(99)90044-x. [PubMed: 10102310].
Hunt K, Hallworth S, Smith M. The effects of rigid collar placement on intracranial and cerebral perfusion pressures. Anaesthesia. 2001;56(6):511-3. doi: 10.1046/j.1365-2044.2001.02053.x. [PubMed: 11412154].
Ho AM, Fung K, Joynt GM, Karmakar MK. Rigid cervical collar and intracranial pressure of patients with severe head injury. J Trauma. 2002;53(6):1185-8. doi: 10.1097/00005373-200212000-00028. [PubMed: 12478051].
Stone MB, Tubridy CM and Curran R. The effect of rigid cervical collars on internal jugular vein dimensions. Acad Emerg Med. 2010;17(1):100-2. doi: 10.1111/j.1553-2712.2009.00624.x. [PubMed: 20015105].
Maissan IM, Ketelaars R, Vlottes B, Hoeks SE, den Hartog D, Stolker RJ. Increase in intracranial pressure by
application of a rigid cervical collar: a pilot study in healthy volunteers. Eur J Emerg Med. 2018;25(6):24-8. doi: 10.1097/MEJ.0000000000000490. [PubMed: 28727580].
Mobbs RJ, Stoodley MA, Fuller J. Effect of cervical hard collar on intracranial pressure after head injury. ANZ J Surg. 2002;72(6):389-91. doi: 10.1046/j.1445-2197.2002.02462.x. [PubMed: 12121154].
Davies G, Deakin C, Wilson A. The effect of a rigid collar
on intracranial pressure. Injury. 1996;27(9):647-9. doi: 10.1016/s0020-1383(96)00115-5. [PubMed: 9039362].
Ozdogan S, Gokcek O, Katirci Y, Corbacioglu SK, Emektar E, Cevik Y. The effects of spinal immobilization at 20 degrees on intracranial pressure. Am J Emerg Med. 2019;37(7):1327-30. doi: 10.1016/j.ajem.2018.10.010. [PubMed: 30327158].
Sanri E, Karacabey S. The impact of head of bed
elevation on optic nerve sheath diameter in cervical collar applied healthy volunteers. J Emerg Med. 2019;56(4):371-7. doi: 10.1016/j.jemermed.2018.12.043. [PubMed: 30709606].
Yard J, Richman PB, Leeson B, Leeson K, Youngblood G, Guardiola J, et al. The influence of cervical collar immobilization on optic nerve sheath diameter. J Emerg Trauma Shock. 2019;12(2):141-4. doi: 10.4103/JETS.JETS_80_18. [PubMed: 31198282].
DeAngelis J, Lou V, Li T, Tran H, Bremjit P, McCann M, et al. Head CT for Minor head ınjury presenting to the emergency department in the Era of choosing wisely. West J Emerg Med. 2017;18(5):821-9. doi: 10.5811/westjem.2017.6.33685. [PubMed: 28874933].
Kuhnigk H, Bomke S, Sefrin P. Effect of external cervical
spine immobilization on intracranial pressure. Aktuelle Traumatologie. 1993;23(8):350-3. [PubMed: 8147253].