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Article

Use of Soft Cervical Collar among Whiplash Patients in Two Italian Emergency Departments Is Associated with Persistence of Symptoms: A Propensity Score Matching Analysis

1
Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg
2
Luxemburg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
3
Department of Clinical Science and Translation Medicine, University of Rome Tor Vergata, 00133 Roma, Italy
4
School of Physiotherapy, University of Verona, 37129 Verona, Italy
5
Polimedico Specialistico STEMA Fisiolab, 04100 Latina, Italy
6
Centro Riabilitativo Agorà Medical, 37057 Verona, Italy
7
Studio Fisioterapico BiàMed, 03043 Cassino, Italy
8
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Campus of Savona, University of Genoa, 17100 Savona, Italy
9
Sovrintendenza Sanitaria Regionale Puglia INAIL, 70126 Bari, Italy
10
Rehabilitation Unit, Azienda ULSS n.9 Scaligera, San Bonifacio, 37047 Verona, Italy
11
Rehabilitation Unit, Azienda ULSS n. 9 Scaligera, Villafranca Di Verona, 37069 Verona, Italy
12
Rehabilitation Unit, Clinica San Francesco, 37127 Verona, Italy
13
Department of Medical Sciences, University of Udine, 33100 Udine, Italy
14
Emergency Department, University Hospital of Verona, 37126 Verona, Italy
15
Emergency Department, General Hospital of Merano (SABES-ASDAA), 39012 Merano, Italy
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work and share first authorship.
Academic Editor: Masahito Hitosugi
Healthcare 2021, 9(10), 1363; https://doi.org/10.3390/healthcare9101363
Received: 13 September 2021 / Revised: 5 October 2021 / Accepted: 7 October 2021 / Published: 14 October 2021
(This article belongs to the Special Issue Traffic Injuries and Prevention)
Purpose: Although the use of soft cervical collars in the emergency department (ED), for whiplash-associated disorders (WAD), is controversial, it is still widely adopted. The purpose of our study was to investigate the impact of the early use of soft cervical collars on the return to the ED, within three months of a road traffic collision. Methods: We conducted a retrospective observational study on WAD patients from two EDs in Verona (Italy). Patients in the earlier acute phase of WAD (within 48 h from the trauma) were included; those with serious conditions (WAD IV) were excluded. As an end point, we considered patients who returned to the ED complaining of WAD symptoms within three months as positive outcome for WAD persistence. Results: 2162 patients were included; of those, 85.4% (n = 1847/2162) received a soft cervical collar prescription. Further, 8.4% (n = 156/1847) of those with a soft cervical collar prescription, and 2.5% (n = 8/315) of those without a soft cervical collar (p < 0.001) returned to the ED within three months. The use of the soft cervical collar was an independent risk factor for ED return within three months, with an OR, adjusted for possible clinical confounders, equal to 3.418 (95% CI 1.653–7.069; p < 0.001). After the propensity score matching, 25.5% of the patients (n = 25/98) using the soft cervical collar returned to the ED at three months, compared to the 6.1% (n = 6/98) that did not adopt the soft cervical collar. The use of a soft cervical collar was associated with ED return with an OR = 4.314 (95% CI 2.066–11.668; p = 0.001). Conclusions: Our study shows that the positioning of the soft collar in a cohort of patients with acute WAD, following a rear-end car collision, is an independent potential risk factor to the return to the ED. Clinically, the use of the collar is a non-recommended practice and seems to be related to an increased risk of delayed recovery. There is a need to inform healthcare providers involved in the ED of the aim to limit the use of the soft cervical collar. A closer collaboration between clinicians (e.g., physicians, physical therapists, nurses) is suggested in the ED. Future primary studies should determine differences between having used or not having used the collar, and compare early physical therapy in the ED compared with the utilization of the collar. View Full-Text
Keywords: cervical collar; whiplash injuries; physical therapy; emergency department; neck cervical collar; whiplash injuries; physical therapy; emergency department; neck
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MDPI and ACS Style

Mourad, F.; Rossettini, G.; Galeno, E.; Patuzzo, A.; Zolla, G.; Maselli, F.; Ciolan, F.; Guerra, M.; Tosato, G.; Palese, A.; Testa, M.; Ricci, G.; Zaboli, A.; Bonora, A.; Turcato, G. Use of Soft Cervical Collar among Whiplash Patients in Two Italian Emergency Departments Is Associated with Persistence of Symptoms: A Propensity Score Matching Analysis. Healthcare 2021, 9, 1363. https://doi.org/10.3390/healthcare9101363

AMA Style

Mourad F, Rossettini G, Galeno E, Patuzzo A, Zolla G, Maselli F, Ciolan F, Guerra M, Tosato G, Palese A, Testa M, Ricci G, Zaboli A, Bonora A, Turcato G. Use of Soft Cervical Collar among Whiplash Patients in Two Italian Emergency Departments Is Associated with Persistence of Symptoms: A Propensity Score Matching Analysis. Healthcare. 2021; 9(10):1363. https://doi.org/10.3390/healthcare9101363

Chicago/Turabian Style

Mourad, Firas, Giacomo Rossettini, Erasmo Galeno, Alberto Patuzzo, Giuseppe Zolla, Filippo Maselli, Federica Ciolan, Michele Guerra, Giacomo Tosato, Alvisa Palese, Marco Testa, Giorgio Ricci, Arian Zaboli, Antonio Bonora, and Gianni Turcato. 2021. "Use of Soft Cervical Collar among Whiplash Patients in Two Italian Emergency Departments Is Associated with Persistence of Symptoms: A Propensity Score Matching Analysis" Healthcare 9, no. 10: 1363. https://doi.org/10.3390/healthcare9101363

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