Quantifying delays in the recognition and management of acute compartment syndrome

Vaillancourt, Christian; Shrier, Ian; Falk, Markus; Rossignol, Michel; Vernec, Alan; Somogyi, Dan

doi:10.1017/s148180350000511x

Cited by 16 publications

(11 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These subjects have already been a part of a published study looking at diagnostic and management delays. 24 The Institutional Review Board in each of the participating hospitals gave their approval for the project. 6,30 these cases were excluded from the initial search and were not reviewed.…”

Section: Methodsmentioning

confidence: 99%

“…9,13,19,[21][22][23] In a previous series of ACS cases presenting to the ED, the median injury-to-operation time interval was greater than 9 hours, suggesting that delays may be the rule rather than the exception. 24 Current opinion on how long muscles can tolerate ischemia is based solely on extrapolations from tourniquet models. According to these models, muscles can tolerate up to 3 hours of ischemia before developing necrosis, [25][26][27][28] and some authors suggest that muscles can tolerate up to 6-8 hours of ischemia.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Acute compartment syndrome: How long before muscle necrosis occurs?

Vaillancourt

Shrier

Vandal

et al. 2004

CJEM

Self Cite

View full text Add to dashboard Cite

Objectives: Acute compartment syndrome (ACS) is a limb-threatening condition often first diagnosed by emergency physicians. Little is known about the rapidity with which permanent damage may occur. Our objective was to estimate the time to muscle necrosis in patients with ACS. Methods: This historical cohort analysis of all patients who had a fasciotomy for ACS was conducted in 4 large teaching hospitals. Diagnosis was confirmed clinically or by needle measurement of compartment pressure. Muscle necrosis was determined using pathology reports and surgeons' operative protocols. We used descriptive statistics and estimated tissue survival probability using the Vertex exchange method for interval-censored data. Results: Between 1989 and 1997 there were 76 cases of ACS. Most cases occurred in young men (median age 32) as a result of a traumatic incident (82%). Forty-nine percent (37/76) of all patients suffered some level of muscle necrosis, and 30% (11/37) of those with necrosis lost more than 25% of the muscle belly. Necrosis occurred in 2 of 4 cases in which the patient had been operated on within 3 hours of the injury, and our exploratory survival analysis estimates that 37% (95% confidence interval, 13%-51%) of all cases of ACS may develop muscle necrosis within 3 hours of the injury. Conclusions: This is the largest cohort of ACS and the first clinical estimation of time to muscle necrosis ever published. Ischemia from ACS can cause muscle necrosis before the 3-hour period post-trauma that is traditionally considered safe. Further research to identify risk factors associated with the development of early necrosis is necessary. RÉSUMÉObjectifs : Le syndrome de loge aigu est une atteinte menaçant l'intégrité des membres qui est souvent diagnostiqué par les médecins d'urgence. On sait peu de choses au sujet de la rapidité à laquelle des lésions permanentes peuvent subvenir. Notre objectif était d'estimer le délai d'instal-

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute compartment syndrome: How long before muscle necrosis occurs?

Vaillancourt

Shrier

Vandal

et al. 2004

CJEM

Self Cite

View full text Add to dashboard Cite

show abstract

“…Another pediatric series from Europe showed that time from presentation to fasciotomy was 27 hours [49]. Vaillancourt et al reported an average time from injury to fasciotomy in adult trauma patients of 9.5 hours [50]. These data not only highlight the difficulty in diagnosing ACS in young patients but also suggest that the evolution of compartment syndrome may be a slower process in children as compared to adults.…”

Section: Pediatric Compartment Syndromementioning

confidence: 98%

Acute compartment syndrome: obtaining diagnosis, providing treatment, and minimizing medicolegal risk

Taylor

Sullivan

Mehta

2012

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

Acute compartment syndrome (ACS) is a surgical emergency. Diagnosis depends on a high clinical suspicion and an understanding of risk factors, pathophysiology and subtle physical exam findings. The typical high risk scenario for ACS is a male patient younger than 35 years of age, involved in a high energy sport or roadway collision, resulting in a tibial shaft fracture. He will go on to develop acute compartment syndrome of the leg in less than 10 hours and require emergent fasciotomy. Diagnosis of ACS in this patient is primarily a clinical one but can be confirmed with invasive intracompartmental pressure monitoring or noninvasive near infrared spectroscopy (NIRS). Delaying the diagnosis will likely result in some degree of permanent disability and places the surgeon at high risk for litigation. This article reviews the salient features of acute compartment syndrome that should be understood by all orthopaedic residents and surgeons.

show abstract

“…Failure to consider the diagnosis of compartment syndrome as well as some late physical manifestations of the disease process (such as loss of pulses) are common causes for the delayed diagnoses of compartment syndrome. [ 10,17,18] Delays in the diagnosis of compartment syndrome can lead to delays in treatment and poor outcome in as short as 4-8 hours [6,7], further emphasizing the need for an early diagnostic tool for compartment syndrome.…”

Section: Resultsmentioning

confidence: 99%