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Table 2 Reviewed articles for jugular vein dimension and intracranial pressure (ICP)

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
Measurements
Craig et al., 1991 [25] UK Case review: Intracranial pressure and collar use Collar use was associated with impaired venous drainage and as such relates to an increase in ICP Only two patients
2 patients
Lemyze et al., 2011 [28] France Case review: Level of consciousness Collar use post hanging may exacerbate cerebral oedema due to compression of neck veins Only one patient
1 patient
Dunham et al., 2008 [32] USA Literature Review Risks with MRI and collar use Collar use is associated with a rise in ICP, and secondary brain injury; early collar removal advocated Evidence supports the theory but no substantial proof
Ho et al., 2002 [7] China Literature Review Intracranial pressure and collar use Collars appear to act like a tourniquet around the neck, potentially exacerbating a head injury and increasing ICP Evidence supports the theory but no substantial proof
Dunham et al., 2011 [8] USA Simulation study Collar use and outcome Early collar removal is advocated for unstable/high risk and stable patients with spinal injuries Simulation study only; no real proof for claims
Davies et al., 1996 [6] UK Study: ICP before and after collar application Stifneck collar may cause a rise in intracranial pressure. Supports hypothesis for collars affecting ICP but exact mechanism for rise in ICP was not determined
19 patients
Hunt et al., 2001 [29] UK Study: ICP before and after collar application Collars are associated with a rise in intracranial pressure, potentially worse if the ICP is higher to start with Supports hypothesis for collars affecting ICP but exact mechanism for rise in ICP was not determined
30 patients
Kolb et al., 1999 [24] USA Study: Cerebrospinal fluid pressure before and after collar application Cerebrospinal fluid pressure increased after collar application, but no clear associated with BMI Collars were placed when the patient was inclined to the side rather than supine; exact mechanism for rise in ICP was not determined
20 patients
Kuhnigk et al., 1993 [30] Germany Study: Intracranial pressure and collar use Found no correlation between collar use and increased intracranial pressure Baseline ICP readings were higher than in other reports and as such may have had an impact on the results
18 patients
Mobbs et al., 2002 [9] Australia Study: ICP before and after collar application Intracranial pressure was higher following the application of a collar Supports hypothesis for collars affecting ICP but exact mechanism for rise in ICP was not determined
10 patients
Stone et al., 2010 [31] USA Study: Jugular vein dimensions before and after collar application Collar application associated with alteration to jugular vein diameter indicative of venous obstruction Supports hypothesis for collars affecting ICP but no mechanism was determined as actual ICP was not measured
42 volunteers
Porter et al., 1999 [27] UK Study: ICP before and after collar application All patients showed a rise in ICP following collar application Supports hypothesis for collars affecting ICP but no mechanism was determined
9 patients
Ferguson et al., 1993 [10] UK Study: Tissue Interface Pressure around neck area Normal jugular venous pressure when supine was 2-7 mmHg, concluded pressures exerted on the neck over this will cause a ‘back pressure’ Supposition rather than fact with the relationship of collar use to increased ICP
5 patients
Raphael et al., 1994 [26] UK Study: Cerebrospinal fluid pressure before and after collar application 7/9 experienced raised cerebrospinal fluid pressure following collar application Supports hypothesis for collars affecting ICP but no mechanism was determined
9 patients