Screening tools in the diagnosis of acute compartment syndrome

Acute compartment syndrome (ACS) is a surgical emergency requiring urgent fasciotomy to save the limb. However, time is of the essence and diagnostic uncertainty can lead to unnecessary surgery. Measurement of intracompartmental pressure (ICP) to aid decision making is becoming commonplace, particularly in unconscious or confused patients. However, inaccurate readings can result from misplacement of the probe, subjecting patients to a needless fasciotomy in the event of an overreading. Similarly, underestimated readings create a false sense of security. Screening tools, criteria-led systems of clinical decision making, are used by some to assist in diagnosis and management planning, but do they work? Here, we review current diagnostic strategies and question whether screening tools can make rapid diagnosis more accurate. Furthermore, in the absence of a standardized tool, we analyze the practice of a sample of vascular surgeons with the aim of moving toward a management consensus useful to junior doctors.