title: Acute lower extremity compartment syndrome (ALECS) screening protocol in critically ill trauma patients.
abstract: BACKGROUND
  Acute lower extremity compartment syndrome (ALECS) is a devastating complication that often presents silently in critically injured patients; therefore, we developed a protocol to screen high-risk patients.
  
  
  METHODS
  This prospective observational study included all Shock Trauma intensive care unit patients who met specific high-risk criteria including pulmonary artery catheter-directed shock resuscitation, open or closed tibial shaft fracture, major vascular injury below the aortic bifurcation, abdominal compartment syndrome, or pelvic or lower extremity crush injury. Patients were screened at admission and every 4 hours thereafter for the first 48 hours of admission. Screening included physical examination (PE) and anterior or deep posterior calf compartment pressure measurements when PE was suspicious or unreliable. A positive screening, defined as a DeltaP <30 mm Hg (where DeltaP is the difference between the diastolic blood pressure and the compartment pressure), mandated a four-compartment fasciotomy.
  
  
  RESULTS
  During a 6-month period, the incidence of ALECS in screened patients was surprisingly high at 20% (9 patients). With diligent screening, it was diagnosed early in the patient's Shock Trauma intensive care unit course. These were patients with severe injuries with an Injury Severity Score of 32.0 +/- 12.5 who exhibited significant volume depletion, with a base deficit of 12.9 +/- 5.9 mEq/L and a lactate level of 13.0 +/- 5.2 mmol/L, requiring large volume resuscitation. Although aggressive fasciotomy resulted in no limb loss, ALECS was associated with an exceedingly high mortality rate at 67%.
  
  
  CONCLUSIONS
  ALECS is an important clinical entity in critically injured patients with trauma associated with significant mortality. Aggressive screening may provide some diagnostic insight to those at risk.
authors: Department of Surgery, General and Teaching Hospital, Maribor, Slovenia.
authors: Roman
authors: R
authors: Kosir
authors: Frederick A
authors: FA
authors: Moore
authors: John H
authors: JH
authors: Selby
authors: Christine S
authors: CS
authors: Cocanour
authors: Rosemary A
authors: RA
authors: Kozar
authors: Ernest A
authors: EA
authors: Gonzalez
authors: S Rob
authors: SR
authors: Todd
mesh_terms: D000180:Acrylic Resins; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000868:Anterior Compartment Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis / Q000401:mortality
chemical_list: D000180:Acrylic Resins; C060386:Triad resin