McGill University Health Centre, Montreal, QC, Canada.
Division of Orthopaedics, Department of Surgery, McGill University, Montreal, QC, Canada; and.
J Orthop Trauma. 2023 Aug 1;37(8):e319-e325. doi: 10.1097/BOT.0000000000002610.
To evaluate whether published studies support basing the diagnosis of compartment syndrome of the lower leg on clinical findings, intracompartmental pressure (ICP) monitoring, or both.
A PubMed/MEDLINE, Web of Science, and Embase search of the English literature from 1966 to February 2022 was performed. This used "lower extremity" or "leg" or "tibia" and "compartment syndrome" and "pressure" as the subjects. A manual search of the bibliographies was performed and cross-referenced with those used to formulate the American Academy of Orthopaedic Surgeons clinical practice guidelines.
Inclusion criteria were traumatic tibia injuries, presence of data to calculate the sensitivity, specificity, positive and negative predictive values of clinical findings and/or pressure monitoring, and the presence or absence of compartment syndrome as the outcome. A total of 2906 full articles were found, of which 63 were deemed relevant for a detailed review. Seven studies met all eligibility criteria.
The likelihood ratio form of Bayes theorem was used to assess the discriminatory ability of the clinical findings and ICP monitoring as tests for compartment syndrome. The predictive value for diagnosing acute compartment syndrome was 21% and 29% for the clinical signs and ICP, respectively. When combining both, the probability reached 68%.
The use of ICP monitoring may be helpful when combined with a clinical assessment to increase the sensitivity and specificity of the overall diagnosis. Previously accepted individual inference values should be revisited with new prospective studies to further characterize the statistical value of each clinical finding.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估基于临床发现、筋膜间室压力（ICP）监测或两者结合来诊断小腿筋膜间室综合征的发表研究是否具有支持性。
对 1966 年至 2022 年 2 月的英文文献进行了 PubMed/MEDLINE、Web of Science 和 Embase 搜索，使用了“下肢”或“腿部”或“胫骨”和“筋膜间室综合征”和“压力”作为主题。对参考文献进行了手动搜索，并与制定美国矫形外科医师学会临床实践指南时使用的参考文献进行了交叉引用。
纳入标准为创伤性胫骨损伤，存在数据以计算临床发现和/或压力监测的敏感性、特异性、阳性和阴性预测值，以及是否存在筋膜间室综合征作为结局。共发现 2906 篇全文，其中 63 篇被认为与详细审查相关。有 7 项研究符合所有入选标准。
使用贝叶斯定理的似然比形式评估临床发现和 ICP 监测作为筋膜间室综合征检测的区分能力。临床体征和 ICP 诊断急性筋膜间室综合征的预测值分别为 21%和 29%。当两者结合时，概率达到 68%。
当与临床评估结合使用时，ICP 监测的使用可能有助于提高总体诊断的敏感性和特异性。应使用新的前瞻性研究重新评估先前接受的个体推断值，以进一步描述每个临床发现的统计学价值。
诊断水平 III。有关证据水平的完整描述，请参见作者说明。
