Cervical Collar in Adult Trauma: Evidence, Controversies, and Clinical Decision-Making.

Abstract

Cervical collars have traditionally been applied routinely in adult trauma to reduce the risk of secondary cervical spinal cord injury. Increasing evidence, however, supports selective spinal motion restriction and earlier collar removal when instability has been adequately excluded. This narrative review evaluates current evidence on collar application, avoidance, clearance, and continued use after confirmed cervical fracture. A structured literature search was conducted across major biomedical databases and guideline sources, with the synthesis guided by the Scale for the Assessment of Narrative Review Articles. In blunt trauma, collar use should be based on clinical risk, examination reliability, mechanism of injury, and phase of care. Routine collaring is generally unsupported in isolated penetrating trauma and may delay time-critical management. In evaluable patients, validated decision rules and high-quality computed tomography (CT) support early clearance when appropriate. In adults with impaired consciousness, collar removal after a negative high-quality CT should be individualized according to neurological findings, clinical context, examination reliability, institutional protocols, and the presence or absence of radio-clinical discrepancy. After fracture confirmation, continued collar use should be individualized according to stability, frailty, treatment goals, and tolerance. Collar-related harms should be incorporated into repeated reassessment. The proposed Four-Domain Trauma Collar Framework organizes these decisions across application, clearance, continuation, and de-escalation but remains a conceptual, unvalidated model.