Acute Compartment Syndrome: Do guidelines for diagnosis and management make a difference?

Area of Science:

• Trauma Surgery
• Orthopedics
• Emergency Medicine

Background:

• Optimal outcomes for Acute Compartment Syndrome (ACS) depend on prompt diagnosis and intervention.
• National guidelines (BOAST 10) were implemented in the UK in 2014 to standardize ACS management.
• This study evaluates diagnostic and management standards before and after BOAST 10 implementation.

Purpose of the Study:

• To assess the impact of national guidelines on Acute Compartment Syndrome (ACS) management.
• To identify variations in ACS care across Major Trauma Centres (MTCs).
• To evaluate the effectiveness of BOAST 10 in improving patient outcomes and care standards.

Main Methods:

• Retrospective review of ACS patients requiring fasciotomy across four UK Major Trauma Centres (MTCs).
• Data collected from March 2010 to May 2015, covering pre- and post-BOAST 10 periods.
• Analysis focused on diagnosis, treatment times, post-operative care, and complication rates.

Main Results:

• 75 fasciotomies were performed; trauma was the primary cause in 56% of cases.
• Median time from decision to fasciotomy was 2 hours; median time to second visit was 2 days.
• BOAST guidelines did not significantly reduce time to surgery, time to second visit, or improve clinical sign recording. Significant variation in post-fasciotomy care was observed.
• 21 patients experienced severe complications, including one fatality and four amputations.

Conclusions:

• Significant variability persists in the definitive management of Acute Compartment Syndrome (ACS).
• National guidelines (BOAST 10) have not demonstrably improved clinical practice or patient outcomes.
• Alternative or supplementary strategies are necessary to ensure consistent and safe management of ACS.