A rising requirement: a number that under-calls

Review and sources

Not clinically reviewed. No clinician has signed this scenario.

• Ulmer T. The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? J Orthop Trauma. 2002;16(8):572-7. Systematic review; 1,932 titles screened, 433 abstracts reviewed, 104 articles examined, 4 studies eligible; sensitivity of clinical findings 13% to 19%; specificity and negative predictive value each 97% to 98%; positive predictive value 11% to 15%; probability of the diagnosis approximately 25% with one clinical finding and 93% with three; clinical features are more useful by their absence in excluding the diagnosis than when present in confirming it.
• McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br. 1996;78(1):99-104. Prospective study of 116 patients with tibial diaphyseal fractures, continuous anterior compartment monitoring for 24 hours; 3 patients (2.6%) had acute compartment syndrome; in the first 12 hours 53 patients had absolute pressures over 30 mmHg and 30 had pressures over 40 mmHg, four higher than 50; only one patient had a differential pressure (diastolic minus compartment) of less than 30 mmHg and had a fasciotomy; two more fell below that differential in the second 12 hours and had fasciotomies; no sequelae in any of the 116 at review at least six months after injury.
• McQueen MM, Duckworth AD, Aitken SA, Court-Brown CM. The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome. J Bone Joint Surg Am. 2013;95(8):673-7. 850 tibial diaphyseal fractures over ten years; estimated sensitivity 94%, specificity 98%, positive predictive value 93%, negative predictive value 99%; of 152 fasciotomies 141 were confirmed acute compartment syndrome and 6 were false positives, with 5 false negatives; of 698 patients without fasciotomy, 689 had no late sequelae at a mean of 59 weeks.