Study Design: An analysis of patients admitted with cervical trauma, comparing: those managed with rigid collars until definitive management; rigid collar usage overnight; and no rigid collar usage from outset.

Objectives: To determine the safety of omitting a rigid collar following cervical trauma, whilst awaiting definitive management.

Summary of Background Data: The use of a rigid collar can result in pain, occipital sores, as well as raised intracranial pressure in head injured patients.

Subjects: Fifty one patients with proven cervical fractures were analysed. Three groups of patients were identified with respect to their initial management after admission to the ward until definitive management: 1) Hard collar, sandbags and bed rest 2) Hard collar in situ overnight and then sandbags and bed rest. 3) Sandbags and bed rest. All patients had full spinal care and precautions, with rigid collars used for any transfers. The spectrum of injury severity was similar throughout all 3 groups.

Outcome measures: Loss of alignment, neurological compromise and complications related to the rigid collar.

Results: There was no loss of reduction or progression of neurological deficit in any group. There were compliance issues in the rigid collar group. Two patients developed occipital skin problems following rigid collar use. All groups proceeded to definitive management successfully.

Conclusion: No significant adverse events were noted in any group. Management without a rigid collar depends on good nursing care. It is more comfortable for the patient and avoids the potential problems encountered with rigid collar use. In compliant patients not requiring immediate definitive management the omission of the rigid collar did not result in loss of reduction or neurological compromise. We feel such collars should be for transport and extrication only.