title: One elevated bladder pressure measurement may not be enough to diagnose abdominal compartment syndrome.
abstract: Bladder pressure measurements (BPMs) are considered a key component in the diagnosis of abdominal compartment syndrome (ACS). The purpose of this observational review was to determine risk factors of ACS and associated mortality with particular focus on the role of BPM. A retrospective  trauma registry and chart review was performed on trauma patients from January 2003 through December 2010. Comparisons were made between patients with and without ACS. There were 3172 patients included in the study of whom 46 had ACS. Patients with ACS were younger, more severely injured,  with longer lengths of stay. Logistic regression determined Injury Severity Score (ISS) and urinary catheter days as independent predictors of ACS, whereas independent predictors of mortality included age, ISS, and ACS. Subset analysis demonstrated no association between BPM 20 mmHg or greater  and diagnosis of ACS versus no ACS. Logistic regression indicated independent predictors of mortality were number of BPM 20 mmHg or greater and age. Patients with ACS are more severely injured with worse outcomes. An isolated BPM 20 mmHg or greater was not associated with ACS and may  be inadequate to independently diagnose ACS. These findings suggest the need for repeat measurements with early intervention if they remain elevated in an effort to decrease mortality associated with ACS.
authors: Division of Trauma/Critical Care and Emergency Surgery, Medical College of Virginia, Physicians and Hospitals, Virginia Commonwealth University Health System, Richmond, VA 23298, USA. ayoung3@mcvh-vcu.edu
authors: Andrew Joseph
authors: AJ
authors: Young
authors: William
authors: W
authors: Weber
authors: Luke
authors: L
authors: Wolfe
authors: Rao R
authors: RR
authors: Ivatury
authors: Therese Marie
authors: TM
authors: Duane
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D059325:Intra-Abdominal Hypertension / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011312:Pressure; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D014160:Transducers, Pressure; D001743:Urinary Bladder / Q000503:physiopathology*; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult