Ayaz Ahmed Abbasi.
Diagnostic utility of Clinical Signs and Symptoms in the Diagnosis of Compartment Syndrome of the Lower Limb.
Ann Pak Inst Med Sci Jan ;7(4):238-41.

Objective: To know the utility of clinical signs and symptoms in the diagnosis of compartment syndrome of the lower limb. Materials and Methods: The literature was searched using following. Medline databases (Ovid interface) 1966 till Nov 2010. Embase (Dialogue data star) 1974 till July 2010. Cochrane Library. Following search terms were used: [{exp compartment syndrome or compartment syndrome.mp or Volkmann’s Ischemic contracture$.mp} AND {exp leg.mp or exp lower extremity} AND {signs.mp or symptoms.mp} AND {exp.diagnosis}] A manual search of the bibliographies of retrieved articles and of major orthopaedic, plastic surgery and general surgery text was also performed. Results: Out of 368 articles reviewed only five fulfilled the inclusion criteria. One review attempted to collate diagnostic performance of pain and other clinical signs but didn’t consistently apply a gold standard. The sensitivity and positive predictive value (13 - 19%) for the clinical findings were low while the specificity and negative predictive value (97 - 98%) were high. The probability of compartment syndrome with one clinical finding was approximately 25%, rising to 93% with three clinical findings present. The results of my survey of North West region of UK showed that 86% to 90% of Registrars were either very confident or confident in excluding compartment syndrome clinically which is in contrary to the evidence found in this review. However 77% of the respondent of the survey admitted that they will use both clinical judgement as well as measurement of compartment pressure (CP) for diagnosing Compartment syndrome (CS) in patients who are unconscious or not able to communicate. Conclusion: The conclusion from this analysis is that there is paucity of good quality data from which to determine the predictive value of clinical findings for the diagnosis of compartment syndrome. However it appears that clinical findings for the diagnosis are of low sensitivity. This is of concern given the proportion of emergency physicians who feel confident to exclude the diagnosis of compartment syndrome on clinical grounds only.

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