What is the role of a pressure gauge in diagnosing compartment syndrome?

From the Guidelines

A pressure gauge plays a crucial role in diagnosing compartment syndrome, particularly in patients who are obtunded, confused, or unco-operative, where clinical signs may be impossible to elicit.

Key Points

• The diagnosis of acute compartment syndrome (ACS) can be challenging, and direct measurement of intracompartmental pressure using a pressure gauge is indicated in doubtful cases 1.
• Various equipment and techniques can be used to measure compartment pressure, including traditional needle manometry, multiparameter monitors, and dedicated transducer-tipped intracompartmental pressure monitors 1.
• The obtained compartment pressure may be affected by the technique and equipment used, and an 18-G needle may lead to an overestimation of compartment pressure by up to 18 mmHg 1.
• A measurement of compartment pressure of 30 mmHg and/or differential pressure (diastolic blood pressure – compartment pressure <30 mmHg) are useful tests for the diagnosis of compartment syndrome 1.

Clinical Application

• In patients with severe limb trauma, repetitive investigation of clinical signs and compartment pressure monitoring is recommended every 30 minutes to 1 hour during the first 24 hours 1.
• The equipment necessary to measure intracompartmental pressure should be available on wards caring for patients at risk of ACS, and staff should be trained in its use 1.

From the Research

Role of Pressure Gauge in Diagnosing Compartment Syndrome

• A pressure gauge is used to measure intracompartmental pressure (ICP) to aid in the diagnosis of acute compartment syndrome (ACS) 2, 3, 4.
• The measurement of ICP is particularly useful in unconscious or confused patients where clinical diagnosis may be uncertain 2.
• However, inaccurate readings can result from misplacement of the probe, leading to unnecessary surgery or a false sense of security if the readings are underestimated 2.
• Different devices are used to measure compartment pressure, including the Stryker device, arterial line manometer, and Whitesides apparatus, each with varying degrees of accuracy 3, 5.
• The accuracy of these devices has been compared in studies, with the arterial line manometer showing the best correlation with calculated control pressures 5.

Diagnostic Strategies

• Clinical examination is the primary method of diagnosing compartment syndrome, with direct compartmental measurements serving an adjunctive role 6.
• Screening tools and criteria-led systems of clinical decision making are used to assist in diagnosis and management planning, but their effectiveness is still being evaluated 2.
• The use of pressure measurements with existing thresholds and formulations may not accurately reflect the presence of compartment syndrome, and other quantitative measures may be needed 6.

Measurement Techniques

• Different needle configurations, such as straight needles, side-port needles, and slit catheters, can affect the accuracy of pressure measurements 5.
• The choice of device and measurement technique can impact the diagnosis and treatment of compartment syndrome, highlighting the need for standardized protocols and further research 3, 5, 4.