Callahan Blake, Ang Darwin, Liu Huazhi
Department of Surgery, University of Central Florida College of Medicine, Orlando, FL, USA.
Department of Surgery, HCA Ocala Hospital, Ocala, FL, USA.
J Trauma Inj. 2024 Jun;37(2):124-131. doi: 10.20408/jti.2023.0077. Epub 2024 May 22.
The aim of this study was to utilize the American College of Surgeons Trauma Quality Improvement Program (TQIP) database to identify risk factors associated with developing acute compartment syndrome (ACS) following lower extremity fractures. Specifically, a nomogram of variables was constructed in order to propose a risk calculator for ACS following lower extremity trauma.
A large retrospective case-control study was conducted using the TQIP database to identify risk factors associated with developing ACS following lower extremity fractures. Multivariable regression was used to identify significant risk factors and subsequently, these variables were implemented in a nomogram to develop a predictive model for developing ACS.
Novel risk factors identified include venous thromboembolism prophylaxis type particularly unfractionated heparin (odds ratio [OR], 2.67; 95% confidence interval [CI], 2.33-3.05; P<0.001), blood product transfusions (blood per unit: OR 1.13 [95% CI, 1.09-1.18], P<0.001; platelets per unit: OR 1.16 [95% CI, 1.09-1.24], P<0.001; cryoprecipitate per unit: OR 1.13 [95% CI, 1.09-1.22], P=0.003).
This study provides evidence to believe that heparin use and blood product transfusions may be additional risk factors to evaluate when considering methods of risk stratification of lower extremity ACS. We propose a risk calculator using previously elucidated risk factors, as well as the risk factors demonstrated in this study. Our nomogram-based risk calculator is a tool that will aid in screening for high-risk patients for ACS and help in clinical decision-making.
本研究旨在利用美国外科医师学会创伤质量改进项目（TQIP）数据库，确定下肢骨折后发生急性骨筋膜室综合征（ACS）的相关危险因素。具体而言，构建了一个变量列线图，以提出下肢创伤后ACS的风险计算器。
使用TQIP数据库进行了一项大型回顾性病例对照研究，以确定下肢骨折后发生ACS的相关危险因素。采用多变量回归来确定显著的危险因素，随后将这些变量应用于列线图中，以建立ACS发生的预测模型。
确定的新危险因素包括静脉血栓栓塞预防类型，尤其是普通肝素（比值比[OR]，2.67；95%置信区间[CI]，2.33 - 3.05；P<0.001）、血液制品输注（每单位血液：OR 1.13[95%CI，1.09 - 1.18]，P<0.001；每单位血小板：OR 1.16[95%CI，1.09 - 1.24]，P<0.001；每单位冷沉淀：OR 1.13[95%CI，1.09 - 1.22]，P = 0.003）。
本研究提供了证据，表明在考虑下肢ACS风险分层方法时，使用肝素和输注血液制品可能是需要评估的额外危险因素。我们提出了一种风险计算器，使用先前阐明的危险因素以及本研究中证实的危险因素。我们基于列线图的风险计算器是一种有助于筛查ACS高危患者并辅助临床决策的工具。
