What are the guideline sources, guidelines and references for Acute compartment syndrome ?
Guideline sources The following summarized guidelines for the evaluation and management of acute compartment syndrome (ACS) are prepared by our editorial team based on guidelines from the Association of Anaesthetists of Great Britain and Ireland (AAGBI 2021), the American Academy of Orthopaedic Surgeons (AAOS 2020), the British Orthopaedic Association (BOA 2014), and the Acute Limb Compartment Syndrome Working Group (ALCS-WG 2010). 1 2 3 4 Guidelines 1. Diagnostic investigations Indications for assessment: As per AAGBI 2021 guidelines: Identify patients at risk of ACS on admission to the hospital or at the time of surgery. C Obtain post-injury and postoperative ward observations and surveillance to identify signs and symptoms of ACS. Use objective scoring charts for ACS identification. C As per BOA 2014 guidelines: https://web.pathway.md/diseases/recbxgvTobKs8b9qM 1/4 6/23/23, 1:44 AM Acute compartment syndrome Pathway s pe O 0 gu de es Assess for ACS as part of the routine evaluation of patients presenting with significant limb injuries, after surgery for limb injuries, and after any prolonged surgical procedure resulting in hypoperfusion of a limb. C Obtain routine nursing limb observations at hourly intervals for early signs of ACS in patients documented to be at risk of ACS. C Clinical examination: As per AAOS 2020 guidelines, obtain serial clinical examination to assist in diagnosing ACS. B As per BOA 2014 guidelines, obtain clinical assessment in patients with limb injuries, including: pain out of proportion to the associated injury pain on passive movement of the muscles of the involved compartments limb perfusion, including capillary refill and distal pulses neurological examination. C Show 3 more Serum biomarkers: consider measuring troponin levels to assist in diagnosing ACS in patients with traumatic lower extremity injury. C Show 2 more Urine biomarkers: Consider obtaining urine myoglobin testing to assist in diagnosing ACS in patients with traumatic lower extremity injury. C Do not use the presence of myoglobinuria to assist in diagnosing ACS in patients with electrical injury. D Other diagnostic modalities: do not obtain other diagnostic modalities (such as EMG or infrared spectroscopy) to guide decision-making for fasciotomy in patients with ACS. D 2. Diagnostic procedures Intracompartmental pressure measurement: As per AAOS 2020 guidelines, consider obtaining intracompartmental pressure monitoring to assist in diagnosing ACS. C Show 3 more As per BOA 2014 guidelines, obtain intracompartmental pressure measurement in situations where the clinical signs are not completely convincing. C 3. Medical management Blood pressure control: maintain normal BP in patients with symptoms or clinical signs of acute decompression syndrome. C https://web.pathway.md/diseases/recbxgvTobKs8b9qM 2/4 6/23/23, 1:44 AM Acute compartment syndrome Pathway 4. Nonpharmacologic interventions Removal of circumferential bandages: remove circumferential dressings and elevate the limb to heart level in all patients with symptoms or clinical signs of compartment syndrome. C 5. Therapeutic procedures Fracture stabilization: Perform operative fixation (external or internal) for initial stabilization of long bone fractures with concomitant ACS requiring fasciotomy. C Perform fracture stabilization using a technique (external fixation/casting) not violating the compartment in patients with evidence of irreversible intracompartmental (neuromuscular/vascular) damage. C Neuraxial anesthesia: As per AAGBI 2021 guidelines: Avoid administering neuraxial or peripheral regional anesthesia resulting in dense blocks of long duration significantly exceeding the duration of surgery. D Recognize that single-shot or continuous peripheral nerve blocks using lower concentrations of local anesthetic drugs without adjuncts do not delay ACS diagnosis, provided post-injury and postoperative surveillance is appropriate and effective. C As per AAOS 2020 guidelines, avoid administering neuraxial anesthesia as it may complicate ACS. Obtain frequent clinical assessment and/or pressure monitoring if neuraxial anesthesia is administered. D As per BOA 2014 guidelines, avoid administering regional anesthesia in high-risk patients as it can mask the symptoms of ACS. D 6. Surgical interventions Indications for fasciotomy: As per AAOS 2020 guidelines, do not perform fasciotomy in adult patients with evidence of irreversible intracompartmental (neuromuscular/vascular) damage. D As per BOA 2014 guidelines, perform urgent surgical decompression in patients with symptoms of ACS persisting 30 minutes after removing circumferential dressings and elevation of the limb. C Show 3 more Fasciotomy technique: As per AAOS 2020 guidelines, recognize that fasciotomy technique (one- versus two-incision, placement of incisions) is less important than achieving complete decompression of the compartments of the affected extremity. C https://web.pathway.md/diseases/recbxgvTobKs8b9qM 3/4 6/23/23, 1:44 AM Acute compartment syndrome Pathway As per BOA 2014 guidelines, perform a 2-incision 4-compartment decompression for lower leg fasciotomies. C Show 2 more Wound care: as per AAOS 2020 guidelines, consider offering negative pressure wound therapy to reduce the time to wound closure and the need for skin grafting in patients with fasciotomy wounds. C 7. Follow-up and surveillance Surgical re-exploration: perform re-exploration at approximately 48 hours, or earlier if clinically indicated, in all patients. C 8. Quality improvement Hospital requirements: As per AAGBI 2021 guidelines, ensure the availability of equipment for intracompartmental pressure measurement on wards caring for patients at risk of ACS. Ensure that the personnel is trained in its use and there are standard operating procedures available and implemented addressing the performance of such measurements and the urgent steps to be taken if measurements are abnormal. C As per BOA 2014 guidelines: Implement a clear, written management policy for patients with diagnostic uncertainty and for patients with risk factors where clinical assessment is not possible (such as reduced level of consciousness). C Ensure that hospitals treating patients with significant injuries have the capability to conduct intracompartmental pressure monitoring. C References 1. Col Patrick M Osborn, Andrew H Schmidt. Management of Acute Compartment Syndrome. J Am Acad Orthop Surg. 2020 Feb 1;28 3):e108-e114. Open 2. No authors listed. Diagnosis and Management of Compartment Syndrome of the Limbs. BOAST. 2014 Jul. Open 3. Christopher J Wall, Joan Lynch, Ian A Harris et al. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma. ANZ J Surg. 2010 Mar;80 3 151 6. Open 4. M H Nathanson, W Harrop-Griffiths, D J Aldington et al. Regional analgesia for lower leg trauma and the risk of acute compartment syndrome: Guideline from the Association of Anaesthetists. Anaesthesia. 2021 Nov;76 11 1518 1525. Open https://web.pathway.md/diseases/recbxgvTobKs8b9qM 4/4