The Diagnosis of Acute Compartment Syndrome

* Delay in the diagnosis of acute compartment syndrome can have severe and potentially disastrous outcomes for the patient. * Factors associated with a delayed diagnosis are lack of experience of medical personnel, regional or general anesthesia, polytrauma cases, injuries to the soft tissue, and the use of clinical signs alone when making the diagnosis. * Youth has been identified as the key risk factor associated with confirmed cases of acute compartment syndrome, and over two-thirds of cases are associated with an underlying fracture. * Although pain is characteristically the index sign associated with the development of acute compartment syndrome, clinical findings in isolation have been proven to have inadequate diagnostic performance characteristics, with sensitivity ranging from 13% to 54%. * Intracompartmental pressure monitoring is recommended for patients at risk, given the documented high estimated sensitivity (94%) and specificity (98%) for the diagnosis of acute compartment syndrome when using a slit catheter technique and a differential pressure threshold of 30 mmHg for >2 hours.