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Quantifying delays in the recognition and management of acute compartment syndrome

Published online by Cambridge University Press:  21 May 2015

Christian Vaillancourt ,
Ian Shrier ,
Markus Falk ,
Michel Rossignol ,
Alan Vernec  and
Dan Somogyi
Christian Vaillancourt
Affiliation:
Department of Emergency Medicine, Sir Mortimer B. Davis–Jewish General Hospital and Royal Victoria Hospital, McGill University, Montreal, Que.
Ian Shrier*
Affiliation:
Department of Clinical Epidemiology and Community Studies Department of Family Medicine, Sir Mortimer B. Davis–Jewish General Hospital, Montreal
Markus Falk
Affiliation:
INOVA Q Inc., Bolzano, Italy
Michel Rossignol
Affiliation:
Department of Clinical Epidemiology and Community Studies
Alan Vernec
Affiliation:
Department of Family Medicine, Sir Mortimer B. Davis–Jewish General Hospital, Montreal
Dan Somogyi
Affiliation:
Department of Family Medicine, University of Pittsburgh, Pittsburgh, Pa, USA
*
Department of Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis–Jewish General Hospital, 3755, chemin côte Ste-Catherine, Montreal QC H3T 1E2; tel 514 340-4562; ishrier@med.mcgill.ca

Abstract

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Objective:

To identify where most efforts should be made to decrease ischemia time and necrosis in acute compartment syndrome (ACS) and to determine the causes for late interventions.

Methods:

This was a multicentre, historical cohort study of patients who underwent fasciotomy for ACS within the McGill Teaching Hospitals between 1989 and 1997. Patients studied had a clinical diagnosis of ACS or compartment pressures greater than 30 mm Hg. In all cases, ACS was confirmed at the time of fasciotomy. Patients were stratified into traumatic and non-traumatic groups, and a step-by-step analysis was performed for each part of the process between injury and operation.

Results:

Among the 62 traumatic ACS cases, the longest delays occurred between initial assessment and diagnosis (median time 2h56, range from 0 to 99h20) and between diagnosis and operation (median 2h13, range 0h15–29h45). Among the 14 non-traumatic ACS cases, delays primarily occurred between inciting event and hospital presentation (median 9h19, range 0h04–289h29) and between initial assessment and diagnosis (median 8h18, range 0–104h15).

Conclusions:

ACS is a limb-threatening condition for which early intervention is critical. Substantial delays occur after the time of patient presentation. For traumatic and non-traumatic ACS, increased physician awareness and faster operating room access may reduce treatment delays and prevent disability.

Keywords

compartment syndromesischemianecrosistime factors
Type
Em Advances • Progrès De La MU
Information
Canadian Journal of Emergency Medicine , Volume 3 , Issue 1 , January 2001 , pp. 26 - 30
Copyright
Copyright © Canadian Association of Emergency Physicians 2001

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