Comparison of three methods for measuring intracompartmental pressure in injured limbs of trauma patients

Abstract

Objectives: To compare three commonly used methods and devices developed for measurement of intracompartmental pressure in injured limbs.

Setting: Level II regional trauma center.

Patients/participants: Consecutive patients treated for extremity trauma suspected to have compartment syndrome.

Intervention: Analysis of compartment pressure data collected using 1) a solid-state transducer intracompartmental catheter; 2) an electronic transducer-tipped catheter; and 3) a modification of Whitesides' needle manometer technique using a straight 18-gauge needle, arterial line transducer, and central venous pressure monitor. All measurements were performed in random order within an area 1.5 cm in diameter.

Main outcome measurements: Statistical analysis evaluating differences in measured data between methods and whether choice of method might alter treatment.

Results: Intracompartmental pressure was measured by each method in 97 muscle compartments in 31 injured limbs of 26 trauma patients suspected to have a compartment syndrome. The overall intraclass correlation coefficient for the three methods was 0.83 (range, 0.77-0.88), indicating only satisfactory agreement among the methods. The mean difference among measurements in each compartment was 8.3 mm Hg (range, 0-51 mm Hg), including 81 (27%) major differences exceeding 10 mm Hg and 72 (24%) minor differences of 6 to 10 mm Hg.

Conclusions: The methods were similar but not completely reliable for measuring intracompartmental pressure in trauma patients. Although all methods appeared useful as aids in diagnosis of compartment syndrome, intracompartmental pressure data, especially single readings, must be interpreted in view of clinical findings.