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Quantifying delays in the recognition and management of acute compartment syndrome

Published online by Cambridge University Press:  21 May 2015

Christian Vaillancourt ,
Ian Shrier ,
Markus Falk ,
Michel Rossignol ,
Alan Vernec  and
Dan Somogyi
Christian Vaillancourt
Affiliation:
Department of Emergency Medicine, Sir Mortimer B. Davis–Jewish General Hospital and Royal Victoria Hospital, McGill University, Montreal, Que.
Ian Shrier*
Affiliation:
Department of Clinical Epidemiology and Community Studies Department of Family Medicine, Sir Mortimer B. Davis–Jewish General Hospital, Montreal
Markus Falk
Affiliation:
INOVA Q Inc., Bolzano, Italy
Michel Rossignol
Affiliation:
Department of Clinical Epidemiology and Community Studies
Alan Vernec
Affiliation:
Department of Family Medicine, Sir Mortimer B. Davis–Jewish General Hospital, Montreal
Dan Somogyi
Affiliation:
Department of Family Medicine, University of Pittsburgh, Pittsburgh, Pa, USA
*
Department of Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis–Jewish General Hospital, 3755, chemin côte Ste-Catherine, Montreal QC H3T 1E2; tel 514 340-4562; [email protected]

Abstract

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Objective:

To identify where most efforts should be made to decrease ischemia time and necrosis in acute compartment syndrome (ACS) and to determine the causes for late interventions.

Methods:

This was a multicentre, historical cohort study of patients who underwent fasciotomy for ACS within the McGill Teaching Hospitals between 1989 and 1997. Patients studied had a clinical diagnosis of ACS or compartment pressures greater than 30 mm Hg. In all cases, ACS was confirmed at the time of fasciotomy. Patients were stratified into traumatic and non-traumatic groups, and a step-by-step analysis was performed for each part of the process between injury and operation.

Results:

Among the 62 traumatic ACS cases, the longest delays occurred between initial assessment and diagnosis (median time 2h56, range from 0 to 99h20) and between diagnosis and operation (median 2h13, range 0h15–29h45). Among the 14 non-traumatic ACS cases, delays primarily occurred between inciting event and hospital presentation (median 9h19, range 0h04–289h29) and between initial assessment and diagnosis (median 8h18, range 0–104h15).

Conclusions:

ACS is a limb-threatening condition for which early intervention is critical. Substantial delays occur after the time of patient presentation. For traumatic and non-traumatic ACS, increased physician awareness and faster operating room access may reduce treatment delays and prevent disability.

Keywords

compartment syndromesischemianecrosistime factors
Type
Em Advances • Progrès De La MU
Information
Canadian Journal of Emergency Medicine , Volume 3 , Issue 1 , January 2001 , pp. 26 - 30
Copyright
Copyright © Canadian Association of Emergency Physicians 2001

References

1.Ashton, H.Effect of inflatable plastic splints on blood flow. Br Med J 1966;2:1427–30.CrossRefGoogle ScholarPubMed
2.Reneman, RS, Slaaf, DW, Lindbom, L, Tangelder, GJ, Arfors, K-E. Muscle blood flow disturbances produced by simultaneously elevated venous and total muscle tissue pressure. Microvasc Res 1980;20:307–18e.Google Scholar
3.Shrier, I, Magder, S.Pressure-flow relationships in an in vitro model of compartment syndrome. J Appl Physiol 1995;79:214–21.Google Scholar
4.Shrier, I, Magder, S.Critical closing pressure and arterial resistance in an in vitro model of compartment syndrome. Med Sci Sports Exerc 1994;26(Abstract suppl.):S162.CrossRefGoogle Scholar
5.Ruiz, E.Compartment syndromes. In: Tintinalli, JE, Ruiz, E, Krome, RL, editors. Emergency medicine: a comprehensive study guide, 4th ed. New York: McGraw-Hill; 1996. p. 1307–11.Google Scholar
6.Menetrey, J, Peter, R.Syndrome de loge aigu de jambe post-trauma-tique. Rev Chir Orthop Reparatrice Appar Mot 1998;84:272–80.Google Scholar
7.Amendola, A, Rorabeck, CH, Vellett, D, Vezina, W, Rutt, B, Nott, l. The use of magnetic resonance imaging in exertional compartment syndromes. Am J Sports Med 1990;18:29–34.CrossRefGoogle ScholarPubMed
8.Balduini, FC, Shenton, DW, O’Connor, KH, Heppenstall, RB.Chronic exertional compartment syndrome: correlation of compartment pressure and muscle ischemia utilizing 31P-NMR spec-troscopy. Clin Sports Med 1993;12:151–65.CrossRefGoogle Scholar
9.Styf, JR, Körner, LM.Microcapillary infusion technique for measurement of intramuscular pressure during exercise. Clin Orthop 1986;207:253–62.CrossRefGoogle Scholar
10.Mabee, JR.Compartment syndrome: a complication of acute extremity trauma. J Emerg Med 1994;12(5):651–6.CrossRefGoogle ScholarPubMed
11.Matsen, FA, Winquist, RA, Krugmire, R.Diagnosis and management of compartment syndromes. J Bone Joint Surg [Am] 1980; 62:286–91.CrossRefGoogle Scholar
12.Rorabeck, CH, Clarke, KM.The pathophysiology of the anterior tibial compartment syndrome: an experimental investigation. J Trauma 1978;18:299–304.CrossRefGoogle ScholarPubMed
13.Welbourn, CRB, Goldman, G, Paterson, IS, Valeri, CR, Shepro, D, Hechtman, HB.Pathophysiology of ischaemia reperfusion injury: central role of the neutrophil. Br J Surg 1991;78:651–5.CrossRefGoogle ScholarPubMed
14.Good, LP.Compartment syndrome: a closer look at etiology and treatment. AORN J 1992;56:904–11.CrossRefGoogle Scholar
15.Haljamäe, H, Enger, E.Human skeletal muscle energy metabolism during and after complete tourniquet ischemia. Ann Surg 1975;182:9–14.CrossRefGoogle ScholarPubMed
16.Heppenstall, RB, Scott, R, Sapega, A, Park, YS, Chance, B.A comparative study of the tolerance of skeletal muscle to ischemia. J Bone Joint Surg [Am] 1986;68:820–8.CrossRefGoogle ScholarPubMed
17.Miller, SH, Price, G, Buck, D, Neeley, J, Kennedy, TJ, Graham, WP, et al. Effects of tourniquet ischemia and postischemic edema on muscle metabolism. J Hand Surg 1979;4:547–55.CrossRefGoogle ScholarPubMed
18.Sapega, A, Heppenstall, RB, Chance, B, Park, YS, Sokolow, D.Optimizing tourniquet application and release times in extremity surgery: a biochemical and ultrastructural study. J Bone Joint Surg [Am] 1985;67:303–14.CrossRefGoogle ScholarPubMed
19.Vaillancourt, C, Shrier, I, Falk, M, Rossignol, M, Vernec, A, Som-ogyi, D.Acute compartment syndrome: a tissue survival analysis [abstract]. CJEM 1999;1(3):190.Google Scholar
20.Quinn, RH, Ruby, ST.Compartment syndrome after elective re-vascularization for chronic ischemia. Arch Surg 1992;127:865–6.CrossRefGoogle Scholar
21.Beveridge, R, Clarke, B, Janes, L, Savage, N, Thompson, J, Dodd, G, et al. Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. CJEM 1999;1 (3 Suppl).Google Scholar
22.Ramesh, S, Dehn, TC, Galland, RB.A traumatic deterioration in general surgeons’ access to emergency theatre. Ann R Coll Surg Engl 1997;79 (2 Suppl):66–7.Google Scholar
23.Lovett, BE, Katchburian, MV.Emergency surgery: half a day does make a difference. Ann R Coll Surg Engl 1999;81:62–4.Google Scholar
24.Dexter, F, Macario, A, Lubarsky, DA, Burns, DD.Statistical method to evaluate management strategies to decrease variability in operating room utilization: application of linear statistical modeling and Monte Carlo simulation to operating room management. Anesthesiology 1999;91:262–74.CrossRefGoogle ScholarPubMed
25.Overdyk, FL, Harvey, SC, Fishman, RL, Shippey, F.Successful strategies for improving operating room efficiency at academic institutions. Anesthesia Analgesia 1998;86:896–906.Google Scholar
26.Styf, J, Wiger, P.Abnormally increased intramuscular pressure in human legs: comparison of two experimental models. J Trauma 1998;45:133–9.CrossRefGoogle ScholarPubMed