Noninvasive Measurement of Compartment Syndrome

Abstract

This study compared the effectiveness of a commercially available invasive intracompartmental pressure measuring device with an investigational noninvasive hardness measuring device in 75 patients undergoing examination for possible compartment syndrome. Legs, forearms, thighs, and arms were tested. Pressure values and hardness ratios were compared to one another as continuous variables and to the clinical diagnosis of compartment syndrome as discrete variables. The compartment with the highest pressure reading within a limb diagnosed with compartment syndrome was compared to limbs without compartment syndrome. Due to the low specificity of the noninvasive measurement of hardness compared to the invasive pressure measurement (0.82 versus 0.96), this study does not support the use of the hardness monitor in the. diagnosis of compartment syndrome.

Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis

“…Most studies (5 of 7) 20–23,26 used similar clinical diagnostic criteria as gold standard for diagnosing ACS: pain out of proportion, weakness, hypoesthesia, tenseness, and pain on passive stretch of the affected muscle. Other signs included were swelling and change in skin color as reported by Janzing et al 23 and Gibson et al 22 The Gibson study also used weakness of the extensor hallucis longus at follow-up as a sign of missed ACS.…”

“…Seven articles met all the inclusion criteria and reported the clinical findings and ICP data, where the positive and negative predictive values could be derived (Table 1). [20][21][22][23][24][25][26] A total of 165 tibias were included in the meta-analysis of the clinical diagnosis and 1281 tibias for the ICP group. All studies were prospective in nature except one by McQueen et al 24 This study had the biggest cohort size (n = 850).…”

“…Regarding the applicability section, McQueen et al 24 had high risk of bias in the "reference standard" domain and unclear risk of bias in the "index test" domain. Gibson et al 22 obtained some risk of bias in the "reference standard" domain of the applicability section (see Most studies (5 of 7) [20][21][22][23]26 used similar clinical diagnostic criteria as gold standard for diagnosing ACS: pain out of proportion, weakness, hypoesthesia, tenseness, and pain on passive stretch of the affected muscle. Other signs included were swelling and change in skin color as reported by Janzing et al 23 and Gibson et al 22 The Gibson study also used weakness of the extensor hallucis longus at follow-up as a sign of missed ACS.…”

“…Large et al 12 has reported on the inaccuracy of single-stick devices. The study by Dickson et al 21 used a single measurement protocol and reports a relatively low sensitivity with a value of 67%. On the other hand, the specificity of such technique was 96%.…”

Extremity compartment syndrome: A review with a focus on non-invasive methods of diagnosis

“…The correlation coefficient with the IMP measurement in both cases ranged from 0.87 to 0.99. The device was further tested on 75 patients with suspected ECS ( Dickson et al, 2003 ). The results showed the specificity of 82% in ECS detection with the tested device compared to 96% of the invasive IMP measurement method.…”