Regional oximetry for diagnosing compartment syndrome: a scoping review

Diagnosis of compartment syndrome remains challenging, as intracompartmental pressure (ICP) monitoring measures mechanical pressure rather than tissue perfusion. Near-infrared spectroscopy (NIRS) enables non-invasive, continuous assessment of tissue oxygen saturation (StO₂), potentially identifying ischemia earlier. However, its diagnostic accuracy remains uncertain.

Following PRISMA-ScR guidelines, PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, and WHO-ICTRP were searched to April 2025 for studies evaluating NIRS in acute (ACS) or chronic exertional (CECS) compartment syndrome. Data on diagnostic accuracy, device protocols, and patient characteristics were extracted. Studies reporting comparable StO₂ data in CECS and controls were pooled using a random-effects meta-analysis.

Twenty-three studies (n = 1000) were included. In ACS, some demonstrated strong correlation with perfusion pressure and post-fasciotomy StO₂ recovery, while others found poor agreement with ICP or no diagnostic discrimination. There was heterogeneity in device type, patient demographics (particularly skin pigmentation), and protocols. In CECS, pooled analysis showed lower baseline StO₂ (mean difference - 3.4%, 95% CI - 6.2 to - 0.7) and greater exercise-induced deoxygenation (+ 15.0%, 95% CI 0.4-29.7) versus controls.

NIRS provides a physiologically relevant but technically variable indicator of compartmental perfusion, which may complement, but not replace, ICP monitoring for compartment syndrome. The results presented are hypothesis-generating and require prospective trials with standardised protocols, inclusive calibration, and prospective validation before clinical adoption of NIRS.