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Observational Study
. 2020 Jun;34(6):287-293.
doi: 10.1097/BOT.0000000000001719.

Perfusion Pressure Lacks Diagnostic Specificity for the Diagnosis of Acute Compartment Syndrome

Andrew H Schmidt  1 , Junrui Di  2 , Vadim Zipunnikov  2 , Katherine P Frey  3 , Daniel O Scharfstein  2 , Robert V O'Toole  4 , Michael J Bosse  5 , William T Obremskey  6 , Daniel J Stinner  7 , Roman Hayda  8 , Madhav A Karunakar  5 , David J Hak  9 , Eben A Carroll  10 , Susan C J Collins  3 , Ellen J MacKenzie  3 ; METRC
Collaborators, Affiliations
Observational Study

Perfusion Pressure Lacks Diagnostic Specificity for the Diagnosis of Acute Compartment Syndrome

Andrew H Schmidt et al. J Orthop Trauma. 2020 Jun.

Abstract

Objective: To evaluate the diagnostic performance of perfusion pressure (PP) thresholds for fasciotomy.

Design: Prospective observational study.

Setting: Seven Level-1 trauma centers.

Patients/participants: One hundred fifty adults with severe leg injuries and ≥2 hours of continuous PP data who had been enrolled in a multicenter observational trial designed to develop a clinical prediction rule for acute compartment syndrome (ACS).

Main outcome measurements: For each patient, a given PP criterion was positive if it was below the specified threshold for at least 2 consecutive hours. The diagnostic performance of PP thresholds between 10 and 30 mm Hg was determined using 2 reference standards for comparison: (1) the likelihood of ACS as determined by an expert panel who reviewed each patient's data portfolio or (2) whether the patient underwent fasciotomy.

Results: Using the likelihood of ACS as the diagnostic standard (ACS considered present if median likelihood ≥70%, absent if <30%), a PP threshold of 30 mm Hg had diagnostic sensitivity 0.83, specificity 0.53, positive predictive value 0.07, and negative predictive value 0.99. Results were insensitive to more strict likelihood categorizations and were similar for other PP thresholds between 10- and 25-mm Hg. Using fasciotomy as the reference standard, the same PP threshold had diagnostic sensitivity 0.50, specificity 0.50, positive predictive value 0.04, negative predictive value 0.96.

Conclusion: No value of PP from 10 to 30 mm Hg had acceptable diagnostic performance, regardless of which reference diagnostic standard was used. These data question current practice of diagnosing ACS based on PP and suggest the need for further research.

Level of evidence: Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.

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References

    1. Hargens AR, Schmidt DA, Evans KL, et al. Quantitation of skeletal-muscle necrosis in a model compartment syndrome. J Bone Joint Surg Am. 1981;63-A:631–636.
    1. Matsen FA III, Winquist RA, Krugmire RB. Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am. 1980;62-A:286–291.
    1. McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures: the pressure threshold for decompression. J Bone Joint Surg Br. 1996;78-B:99–104.
    1. Mubarak SJ, Owen CA, Hargens AR, et al. Acute compartment syndromes: diagnosis and treatment with the aid of the wick catheter. J Bone Joint Surg Am. 1978;60:1091–1095.
    1. Heppenstall RB, Sapega AA, Scott R, et al. The compartment syndrome. An experimental and clinical study of muscular energy metabolism using phosphorus nuclear magnetic resonance spectroscopy. Clin Orthop Relat Res. 1988;226:138–155.

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