Pressure trends and diagnosis of acute compartment syndrome

Objectives: Acute compartment syndrome (ACS) is a serious condition resulting from increased intracompartmental pressure (ICP) within a closed muscle compartment. There is a lack of understanding of continuous pressure trends despite being an accepted method for tracking disease. It was hypothesized that trends in pressure would determine risk of ACS. Methods: This is a retrospective review of collected data from two prospective cohort trials. Anonymized ICP pressures from 147 trauma patients with extremity fractures were gathered. Patient data from multicenter level one trauma academic hospitals was analyzed. Data was taken from trauma patients that received a continuous real-time pressure device. Statistical and observational analysis were carried out to examine trends in patients with and without resultant acute compartment syndrome. Results: Patients that developed ACS did not always have significantly higher absolute ICPs that exceed the theoretical critical 30 mmHg threshold for fasciotomy. Patients with ACS showed a consistent upward trend over time (average increase of 0.674 mmHg per hour). In contrast, non-ACS patients, even those that exceeded the previous postulated 30mmHg threshold, exhibit a natural and gradual decline in ICP over time (average decline of 0.285 mmHg per hour). Conclusions: This research highlights the limitations of single-point pressure measurements and underscores the benefits of continuous ICP monitoring for timely ACS diagnosis. Continuous pressure data enables better clinical decision-making, reducing the risk of both unnecessary and delayed fasciotomies. This study emphasizes the need for integrating continuous pressure monitoring into standard practice to improve the management and outcomes of patients at risk for ACS.