James A Nelson1. 1. Emergency Department, Pioneers Memorial Hospital, Brawley, California, USA.
Abstract
BACKGROUND: Osseofascial compartment syndrome is defined by ischemic necrosis of muscle caused by elevated pressure within fascial compartments. The diagnosis can be made either clinically or through compartment pressure measurements. Compartment pressure above 30 mm Hg was traditionally used as the threshold for diagnosis of compartment syndrome, but was challenged due to a high number of false-positive results. Perfusion pressure (diastolic blood pressure - compartment pressure) <30 mm Hg came to be promoted as a confirmatory diagnostic test. OBJECTIVE: The objective of this article is to review the specificity of perfusion pressure for compartment syndrome in the acutely traumatized limb. DISCUSSION: Perfusion pressure has been shown to generate false-positive results in 18-84% of patients with tibial fractures. Two studies showed that not a single patient with measurements qualifying for fasciotomy actually needed the procedure. CONCLUSION: Both absolute compartment pressure and tissue perfusion pressure generate a high rate of false-positive results in the acutely traumatized limb. An alternative diagnostic test or process is needed to prevent overtreatment. In the meantime, emergency medicine and orthopedic surgery textbooks and guidelines should promote awareness of the limitations of the test.
BACKGROUND: Osseofascial compartment syndrome is defined by ischemic necrosis of muscle caused by elevated pressure within fascial compartments. The diagnosis can be made either clinically or through compartment pressure measurements. Compartment pressure above 30 mm Hg was traditionally used as the threshold for diagnosis of compartment syndrome, but was challenged due to a high number of false-positive results. Perfusion pressure (diastolic blood pressure - compartment pressure) <30 mm Hg came to be promoted as a confirmatory diagnostic test. OBJECTIVE: The objective of this article is to review the specificity of perfusion pressure for compartment syndrome in the acutely traumatized limb. DISCUSSION: Perfusion pressure has been shown to generate false-positive results in 18-84% of patients with tibial fractures. Two studies showed that not a single patient with measurements qualifying for fasciotomy actually needed the procedure. CONCLUSION: Both absolute compartment pressure and tissue perfusion pressure generate a high rate of false-positive results in the acutely traumatized limb. An alternative diagnostic test or process is needed to prevent overtreatment. In the meantime, emergency medicine and orthopedic surgery textbooks and guidelines should promote awareness of the limitations of the test.