Quantifying delays in the recognition and management of acute compartment syndrome.

OBJECTIVE

To identify where most efforts should be made to decrease ischemia time and necrosis in acute compartment syndrome (ACS) and to determine the causes for late interventions.

METHODS

This was a multicentre, historical cohort study of patients who underwent fasciotomy for ACS within the McGill Teaching Hospitals between 1989 and 1997. Patients studied had a clinical diagnosis of ACS or compartment pressures greater than 30 mm Hg. In all cases, ACS was confirmed at the time of fasciotomy. Patients were stratified into traumatic and non-traumatic groups, and a step-by-step analysis was performed for each part of the process between injury and operation.

RESULTS

Among the 62 traumatic ACS cases, the longest delays occurred between initial assessment and diagnosis (median time 2h56, range from 0 to 99h20) and between diagnosis and operation (median 2h13, range 0h15-29h45). Among the 14 non-traumatic ACS cases, delays primarily occurred between inciting event and hospital presentation (median 9h19, range 0h04-289h29) and between initial assessment and diagnosis (median 8h18, range 0-104h15).

CONCLUSIONS

ACS is a limb-threatening condition for which early intervention is critical. Substantial delays occur after the time of patient presentation. For traumatic and non-traumatic ACS, increased physician awareness and faster operating room access may reduce treatment delays and prevent disability.