Long-term physical outcome of patients who suffered crush syndrome after the 1995 Hanshin-Awaji earthquake: prognostic indicators in retrospect.
BACKGROUND
The 372 cases of crush syndrome that followed the 1995 Hanshin-Awaji earthquake have provided a unique opportunity to investigate the long-term physical outcomes and to establish indications for specific treatments in such patients. The objectives of this study were to identify independent predictors of physical outcome in patients suffering from crush syndrome and to clarify the influence of fasciotomy on outcomes.


METHODS
Sensory and motor functions were examined 2 years after the earthquake in 42 patients with a total of 58 compressed lower extremities. The influences of time to rescue, fasciotomy, and radical debridement on lower leg muscle strength were evaluated by stepwise regression analysis. Correlation between the time to fasciotomy and lower leg muscle strength was also analyzed.


RESULTS
Severe disabilities related to the lower leg compartment were present in 47% (8/17) of patients who underwent fasciotomy and in 16% (4/25) of patients who did not. The anterior compartment was damaged more severely than the posterior compartment. Severe sensory and motor disturbances occurred at a higher rate in relation to anterior and posterior compartments that were treated by fasciotomy than in relation to those that were not. Stepwise regression analysis showed fasciotomy/debridement score to be an independent predictor of long-term lower leg muscle strength (R = 0.67, p < 0.0001) and showed time to rescue to be an independent predictor when debrided compartments were not included in the analysis (R = 0.36, p = 0.009). In all debrided anterior compartments, muscle contractility was completely abolished. There was a significant negative correlation between time to fasciotomy and lower leg muscle strength.


CONCLUSIONS
Secondary compartment syndrome affects physical outcome in crush syndrome patients. We obtained no evidence that fasciotomy improves outcome. Delayed rescue, delayed fasciotomy, and radical debridement may worsen the physical prognosis. Indications for fasciotomy in crush syndrome during the acute phase need further deliberation.
Matsuoka
Tetsuya
T
Senshu Critical Care Medical Center, Osaka, Japan. matsuoka@sccmc.izumisano.osaka.jp
Yoshioka
Toshiharu
T
Tanaka
Hiroshi
H
Ninomiya
Norihisa
N
Oda
Jun
J
Sugimoto
Hisashi
H
Yokota
Junichiro
J
D000328:Adult; D000368:Aged; D019245:Compressive Strength / Q000502:physiology; D003444:Crush Syndrome / Q000503:physiopathology / Q000601:surgery*; D003646:Debridement; D004190:Disasters; D005205:Fascia / Q000503:physiopathology; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011597:Psychomotor Performance / Q000502:physiology; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors; D015599:Trauma Severity Indices