Only one low quality study (Dickson, 2003) meeting the inclusion criteria for this CPG was found that addressed any diagnostic modalities other than clinical or pressure testing. This study showed that in patients with a clinical diagnosis suggesting or confirming compartment syndrome, a “hardness ratio” of 2 or more had a weak association to the reference standard of a clinical diagnosis of ACS (as determined by the attending physician’s clinical assessment). Hardness measurements were made using an investigational device consisting of a force plate that was applied to the skin. The hardness of the compartment with the highest compartment pressure was comparted to the final clinical assessment, and diagnostic parameters calculated. In particular, this diagnostic method had low specificity, resulting in a significant number of false positive diagnoses, leading the authors not to recommend this as a useful diagnostic modality.
Many other examples of alternative diagnostic modalities have been considered to be of potential value for the diagnosis of ACS, including near-infrared spectroscopy (NIRS), electromyography (EMG), and pH testing. However, at the time of publication of this CPG, these modalities were not supported by any published literature meeting the inclusion criteria for this review. It is the opinion of the panel that this is an area of significant research with potential clinical impact, and readers should continue to review the published literature as new data regarding new diagnostic modalities for ACS become available.
POSSIBLE HARMS OF IMPLEMENTATION
Misdiagnosis could lead irreversible intracompartmental damage.
Studies examining the sensitivity and specificity of various diagnostic modalities (e.g. NIRS, Imaging, NCS, etc.) as compared to an appropriate reference standard (e.g. validated and/or comprehensive clinical and pressure diagnosis) in a population of patients suspected of ACS may have significant impact on clinicians’ ability to accurately diagnose acute compartment syndrome in a timely fashion.