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Table 1 Reviewed articles for tissue interface pressure

From: The measurement of tissue interface pressures and changes in jugular venous parameters associated with cervical immobilisation devices: a systematic review

Reference Country Article type & subjects Observations Key findings Weaknesses
Jacobsen et al., 2008 [5] USA Literature review Reduction in occipital pressure ulcers Improved nursing education and a variety of collars caused an reduction in occipital ulcer incidence Only looked at their own trauma centre
Liew et al., 1994 [13] Australia Case review: 2 patients Pressure ulcer development Ulceration is a complication of hard collar use Only looked at 2 patients
Murphy et al., 1997 [14] USA Case review: 1 patient Pressure ulcer development Occipital pressure ulcers after collar use are common; improved wound care/more suitable collars advised Only one patient reviewed
Walker, 2012 [4] UK Retrospective analysis: Pressure ulcer development Cervically immobilised patients have an increased risk of developing pressure ulcers Looked at all types of immobilisation not just semi-rigid collars
90 patients
Powers, 1997 [20] USA Retrospective analysis Pressure ulcer development Improved education, more suitable collars plus early collar removal protocol resulted in a ulcer reduction Only looked at their own trauma centre
Blaylock, 1996 [19] USA Retrospective analysis and study: 20 patients Pressure ulcer development Improved education on skin condition/wound care and collar fitting, plus a new collar design resulted in no ulcers in the subjects. Possibility that the team were conscious regarding ulcer development. Small sample size and only one trauma centre included
Molano et al., 2004 [15] Spain Retrospective study: Pressure ulcer development 23.9% had ulcers; with occipital ulcers being more problematic to treat Only looked at their own unit
92 patients
Chendrasekhar et al., 1998 [21] USA Retrospective study: Pressure ulcer development Ulceration is related to duration of collar wear; early collar removal advocated Only 34 patients actually included due to mortality and only 8 had their collar removed earlier than normal
52 patients
Beavis, 1989 [17] UK Study: 10 volunteers, Tissue Interface Pressure at chin and occiput Passive and active results showed wide variance, but Beavis felt that the pressure was a positive feature, being an incentive not to move No consideration for the impact of high interface pressure
4 collars
(25-172 mmHg)
Black et al., 1998 [22] USA Study: 20 volunteers, Tissue Interface Pressure at occiput (39-83 mmHg) plus skin temperature and humidity No difference between the interface pressures of the collars was found; felt skin humidity was an important factor in ulcer development Collars were worn for up to 30 minutes possibly impacting on pressure readings due to foam compression within the collar
2 collars
Ferguson et al., 1993 [10] UK Study: 5 patients, Tissue Interface Pressure around neck area (1.2-11.8 mmHg) Pressures recorded depended on the tightness of the collar Sensor positions were possibly not indicative of true pressure points; tensions applied were subjective
6 collars
Fisher, 1978 [16] USA Study: 8 patients, Tissue Interface Pressure at chin an d occiput Passive interface pressures varied with collar tightness: Used the same person to apply the collar; ‘tightness’ was subjective
1 collar
(25-105 mmHg)
Plaisier et al., 1994 [18] USA Study: 20 volunteers, Tissue Interface Pressure at chin, occiput and mandible (27-57 mmHg); plus comfort Philadelphia/Stifneck collars exceed capillary closing pressure in some positions, yet Newport/Miami J did not; comfort ratings tallied with this Skin humidity temperature data would have confirmed their ‘skin friendly’ endorsement of the Newport and Miami J collar
4 collars
Tescher et al., 2007 [23] USA Study: 48 patients, Tissue Interface Pressure at occiput and mandible Miami J/Miami J with Occian back had lower pressures recorded both seated and supine; however all maximal pressures recorded exceeded capillary closing pressure Admit that interface pressure is an important consideration in ulcer development but admit other factors may play an important part
4 collars