Can secondary extremity compartment syndrome be diagnosed earlier?
BACKGROUND
In 2002, our institution published a 5-year retrospective review of 10 patients who developed secondary extremity compartment syndrome (SECS) with a mortality rate of 70%. Since then, we have aggressively screened for the development of SECS in high-risk patients. We postulate that awareness of SECS and vigilant monitoring for its development would result in earlier diagnosis and treatment and improved outcome.


METHODS
Retrospective review of all patients at a level I trauma center developing SECS from 2002 to 2006. Data collected included demographics, mechanism of injury, injury complex, blood transfused prior to development of SECS, affected extremities, creatinine, creatine phosphokinase, management, and outcome.


RESULTS
Seventeen of 11,468 trauma patients (.148%) developed SECS. Mean admission hematocrit was 31.7 +/- 8.9, mean admission base deficit was -13.3, mean worst base deficit was -17.8, and average Injury Severity Score was 36.3 +/- 16.6. Patients received 20.9 +/- 11.0 units of blood and 24.6 +/- 14 L of crystalloid prior to the development of SECS. Average time from admission to diagnosis of the SECS was 32.6 hours. Acute renal failure developed in 6 (35%) patients; 4 required dialysis, and 3 died. The number of affected extremities ranged from 1 to 4. Of the 46 affected extremities, 39 were salvaged and 7 required amputation. Mortality was 35.3%.


CONCLUSIONS
SECS is an uncommon, but devastating complication in severely injured patients with hypotension undergoing massive transfusion, and developing systemic inflammatory response syndrome. Vigilance increases detection. While the overall mortality was reduced by half, patients requiring dialysis have a 75% mortality.
Goaley
Thomas J
TJ
Grady Memorial Hospital, Emory University, Thomas K. Glenn Memorial Building, 69 Jesse Hill Jr. Dr, Suite 310, Atlanta, GA 30303, USA.
Wyrzykowski
Amy D
AD
MacLeod
Jana B A
JB
Wise
Kevin B
KB
Dente
Christopher J
CJ
Salomone
Jeffrey P
JP
Nicholas
Jeffrey M
JM
Vercruysse
Gary A
GA
Ingram
Walter L
WL
Rozycki
Grace S
GS
Feliciano
David V
DV
D000328:Adult; D003161:Compartment Syndromes / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014948:Wounds, Gunshot / Q000150:complications; D014949:Wounds, Nonpenetrating / Q000150:complications