Diagnosing acute compartment syndrome – where have we got to?
The most common threshold used by clinicians when assessing compartment pressures remains the delta pressure. The delta pressure is the result of the diastolic blood pressure minus the intra-compartmental pressure found when measuring the pressure with a [STIC Intra-Compartmental] pressure monitor.
A significant amount of work has been put into developing modalities of diagnosing for acute compartment syndrome in the last 15 years. Since the previous review performed by the senior author, there has been substantial developments in modalities of diagnosing, both with respect to measuring intra-compartmental pressure. There is a lot of promising outcomes that have been reported, however, there is yet to be any conclusive evidence to suggest that they should be used over intra-compartmental pressures which continues to remain the gold standard.
Intervention and Outcome Summary
McQueen et al. found the sensitivity and specificity of continuous intra-compartmental pressure monitoring to be high, with estimated positive and negative predictive values of 93% and 99% respectively. The proposed benefit of continuous monitoring is that it reduces the influence of potentially erroneous single readings, but additionally it allows a trend to be identified that may well facilitate the diagnosis prior to clinical signs developing. No matter the method used to diagnose acute compartment syndrome, the implementation of treatment is time critical. Simple measures such as splitting casts or unwinding compression dressings can make a large difference and thus raise the importance of regular review. Therefore, pressure monitoring is ideally used in situations where clinical suspicion is raised.
Tristan E. McMillan, William Timothy Gardner, Andrew H. Schmidt, Alan J. Johnstone