The diagnosis of acute compartment syndrome: a review

Delay in the diagnosis of acute compartment syndrome (ACS) has serious and sometimes catastrophic consequences for the outcome of injury, and has been recognised as one of the primary causes of a poor outcome. This article reviews the evidence for the use of clinical findings and intra-compartmental pressure (ICP) monitoring in making a prompt diagnosis of ACS. Clinical findings have poor sensitivities (13-64 %) compared to ICP monitoring (94 %) using a differential pressure threshold of less than 30 mmHg for more than 2 h. The specificities of clinical findings range from 63 to 98 % compared to a value of 98 % for ICP monitoring. Patients at risk of ACS or at risk of a delayed diagnosis are defined, and it is recommended that these patients undergo ICP monitoring. It is recommended that decompression is carried out primarily on the basis of the differential pressure being less than 30 mmHg for more than 2 h as this results in a reduced time to definitive treatment when compared to waiting for the development of clinical symptoms and signs.