We read your editorial on ‘Early diagnosis of compartment syndrome: Continuous pressure
measurement or not?’
1
with interest and not a little trepidation for the management of future patients
in the NHS. Your message is that ICP monitoring is unnecessary. However we feel that
we should point out that there is evidence that the traditional clinical signs of
compartment syndrome are at best often difficult to interpret. Ulmer, in his analysis
of the usefulness of these signs, showed that the classical clinical signs had a sensitivity
of 13–19% and a positive predictive value of only 11–15%.
2
The editorial mentions that Ulmer stated that if three clinical signs were present
the probability of a compartment syndrome was 93%. However it did not state that one
of the clinical signs was paralysis which, if allowed to develop, precludes full recovery!
If one relies on clinical signs one must be very careful about underdiagnosing compartment
syndrome.To read this article in full you will need to make a payment
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References
- Early diagnosis of tibial compartment syndrome: continuous pressure measurement or not?.Injury. 2009; 40: 341-342
- The clinical diagnosis of compartment disorder of the lower leg: are clinical findings predictive of the disorder?.J Orthop Trauma. 2002; 16: 572-577
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© 2009 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
