Samantha H Lee1, Michael Padilla2, John E Lynch3, Alan R Hargens2. 1. Columbia University Medical Center, New York Presbyterian, Department of Anesthesiology, New York, 10032, USA. 2. University of California, San Diego, Department of Orthopedic Surgery, San Diego, California 92103, USA. 3. CIRS, Inc., 2428 Alameda Ave Ste 316, Norfolk, Virginia 23513, USA.
Abstract
BACKGROUND: We tested a noninvasive ultrasound, Pulse Phase Locked Loop (PPLL) technique for estimating Intramuscular Pressure (IMP) in a model Acute Compartment Syndrome (ACS); and compared it to a Near-Infrared Spectroscopy (NIRS) method. QUESTIONS: We wanted to validate our model compartment syndrome, and to compare and validate the PPLL and NIRS methods of detecting compartment syndrome. METHODS: To simulate the tamponade of an ACS, external-pressure levels from 10 to 70 mm Hg were applied to the legs of 15 healthy adult subjects to raise their IMP. Receiver Operator Characteristic (ROC) curves were used to determine the sensitivity and specificity of diagnosing elevated IMP by the two noninvasive techniques. RESULTS: NIRS data varied significantly with compression (p=0.003) with large subject-to-subject variability (p<0.001). PPLL data also varied significantly with compression (p=0.004), but subject-to-subject variation was not significant (p=0.47), suggesting that individual variation does not affect the diagnostic accuracy of the PPLL technique. Sensitivity and specificity for diagnosing normal IMP by the PPLL (<30 mm Hg from a slit catheter reading) from elevated IMP (>30 mm Hg) were 0.75 and 0.75, respectively, and the area under the curve (AUC) was 0.78. For the NIRS, the sensitivity and specificity were 0.65 and 0.65, respectively, and the AUC was 0.68. CONCLUSIONS: Both NIRS and PPLL recordings are able to differentiate a simulated ACS up to 70 mm Hg. However, the PPLL technique is a slightly better diagnostic predictor than NIRS with less subject-to-subject variability and slightly better sensitivity and specificity. LEVEL OF EVIDENCE: Level II, Diagnostic test.
BACKGROUND: We tested a noninvasive ultrasound, Pulse Phase Locked Loop (PPLL) technique for estimating Intramuscular Pressure (IMP) in a model Acute Compartment Syndrome (ACS); and compared it to a Near-Infrared Spectroscopy (NIRS) method. QUESTIONS: We wanted to validate our model compartment syndrome, and to compare and validate the PPLL and NIRS methods of detecting compartment syndrome. METHODS: To simulate the tamponade of an ACS, external-pressure levels from 10 to 70 mm Hg were applied to the legs of 15 healthy adult subjects to raise their IMP. Receiver Operator Characteristic (ROC) curves were used to determine the sensitivity and specificity of diagnosing elevated IMP by the two noninvasive techniques. RESULTS: NIRS data varied significantly with compression (p=0.003) with large subject-to-subject variability (p<0.001). PPLL data also varied significantly with compression (p=0.004), but subject-to-subject variation was not significant (p=0.47), suggesting that individual variation does not affect the diagnostic accuracy of the PPLL technique. Sensitivity and specificity for diagnosing normal IMP by the PPLL (<30 mm Hg from a slit catheter reading) from elevated IMP (>30 mm Hg) were 0.75 and 0.75, respectively, and the area under the curve (AUC) was 0.78. For the NIRS, the sensitivity and specificity were 0.65 and 0.65, respectively, and the AUC was 0.68. CONCLUSIONS: Both NIRS and PPLL recordings are able to differentiate a simulated ACS up to 70 mm Hg. However, the PPLL technique is a slightly better diagnostic predictor than NIRS with less subject-to-subject variability and slightly better sensitivity and specificity. LEVEL OF EVIDENCE: Level II, Diagnostic test.
Authors: John M Wiemann; Toshiaki Ueno; Bryan T Leek; William T Yost; Alexandra K Schwartz; Alan R Hargens Journal: J Orthop Trauma Date: 2006-07 Impact factor: 2.512
Authors: Michael S Shuler; William M Reisman; Tracy L Kinsey; Thomas E Whitesides; E Mark Hammerberg; Maria G Davila; Thomas J Moore Journal: J Bone Joint Surg Am Date: 2010-04 Impact factor: 5.284
Authors: Michael S Shuler; William M Reisman; Thomas E Whitesides; Tracy L Kinsey; E Mark Hammerberg; Maria G Davila; Thomas J Moore Journal: J Bone Joint Surg Am Date: 2009-06 Impact factor: 5.284