Can secondary extremity compartment syndrome be diagnosed earlier?

Thomas J. Goaley, Amy D. Wyrzykowski, Jana B A MacLeod, Kevin B. Wise, Christopher J. Dente, Jeffrey P. Salomone, Jeffrey M. Nicholas, Gary - Vercruysse, Walter L. Ingram, Grace S. Rozycki, David V. Feliciano

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: In 2002, our institution published a 5-year retrospective review of 10 patients who developed secondary extremity compartment syndrome (SECS) with a mortality rate of 70%. Since then, we have aggressively screened for the development of SECS in high-risk patients. We postulate that awareness of SECS and vigilant monitoring for its development would result in earlier diagnosis and treatment and improved outcome. Methods: Retrospective review of all patients at a level I trauma center developing SECS from 2002 to 2006. Data collected included demographics, mechanism of injury, injury complex, blood transfused prior to development of SECS, affected extremities, creatinine, creatine phosphokinase, management, and outcome. Results: Seventeen of 11,468 trauma patients (.148%) developed SECS. Mean admission hematocrit was 31.7 ± 8.9, mean admission base deficit was -13.3, mean worst base deficit was -17.8, and average Injury Severity Score was 36.3 ± 16.6. Patients received 20.9 ± 11.0 units of blood and 24.6 ± 14 L of crystalloid prior to the development of SECS. Average time from admission to diagnosis of the SECS was 32.6 hours. Acute renal failure developed in 6 (35%) patients; 4 required dialysis, and 3 died. The number of affected extremities ranged from 1 to 4. Of the 46 affected extremities, 39 were salvaged and 7 required amputation. Mortality was 35.3%. Conclusions: SECS is an uncommon, but devastating complication in severely injured patients with hypotension undergoing massive transfusion, and developing systemic inflammatory response syndrome. Vigilance increases detection. While the overall mortality was reduced by half, patients requiring dialysis have a 75% mortality.

Original languageEnglish (US)
Pages (from-to)724-727
Number of pages4
JournalAmerican Journal of Surgery
Volume194
Issue number6
DOIs
StatePublished - Dec 2007
Externally publishedYes

Fingerprint

Compartment Syndromes
Extremities
Mortality
Dialysis
Wounds and Injuries
Systemic Inflammatory Response Syndrome
Injury Severity Score
Trauma Centers
Creatine Kinase
Amputation
Hematocrit
Acute Kidney Injury
Hypotension
Early Diagnosis
Creatinine

Keywords

  • Acute extremity compartment syndrome
  • Fasciotomy
  • Muscle necrosis
  • Resuscitation complications
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Goaley, T. J., Wyrzykowski, A. D., MacLeod, J. B. A., Wise, K. B., Dente, C. J., Salomone, J. P., ... Feliciano, D. V. (2007). Can secondary extremity compartment syndrome be diagnosed earlier? American Journal of Surgery, 194(6), 724-727. https://doi.org/10.1016/j.amjsurg.2007.08.013

Can secondary extremity compartment syndrome be diagnosed earlier? / Goaley, Thomas J.; Wyrzykowski, Amy D.; MacLeod, Jana B A; Wise, Kevin B.; Dente, Christopher J.; Salomone, Jeffrey P.; Nicholas, Jeffrey M.; Vercruysse, Gary -; Ingram, Walter L.; Rozycki, Grace S.; Feliciano, David V.

In: American Journal of Surgery, Vol. 194, No. 6, 12.2007, p. 724-727.

Research output: Contribution to journalArticle

Goaley, TJ, Wyrzykowski, AD, MacLeod, JBA, Wise, KB, Dente, CJ, Salomone, JP, Nicholas, JM, Vercruysse, G, Ingram, WL, Rozycki, GS & Feliciano, DV 2007, 'Can secondary extremity compartment syndrome be diagnosed earlier?', American Journal of Surgery, vol. 194, no. 6, pp. 724-727. https://doi.org/10.1016/j.amjsurg.2007.08.013
Goaley TJ, Wyrzykowski AD, MacLeod JBA, Wise KB, Dente CJ, Salomone JP et al. Can secondary extremity compartment syndrome be diagnosed earlier? American Journal of Surgery. 2007 Dec;194(6):724-727. https://doi.org/10.1016/j.amjsurg.2007.08.013
Goaley, Thomas J. ; Wyrzykowski, Amy D. ; MacLeod, Jana B A ; Wise, Kevin B. ; Dente, Christopher J. ; Salomone, Jeffrey P. ; Nicholas, Jeffrey M. ; Vercruysse, Gary - ; Ingram, Walter L. ; Rozycki, Grace S. ; Feliciano, David V. / Can secondary extremity compartment syndrome be diagnosed earlier?. In: American Journal of Surgery. 2007 ; Vol. 194, No. 6. pp. 724-727.
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title = "Can secondary extremity compartment syndrome be diagnosed earlier?",
abstract = "Background: In 2002, our institution published a 5-year retrospective review of 10 patients who developed secondary extremity compartment syndrome (SECS) with a mortality rate of 70{\%}. Since then, we have aggressively screened for the development of SECS in high-risk patients. We postulate that awareness of SECS and vigilant monitoring for its development would result in earlier diagnosis and treatment and improved outcome. Methods: Retrospective review of all patients at a level I trauma center developing SECS from 2002 to 2006. Data collected included demographics, mechanism of injury, injury complex, blood transfused prior to development of SECS, affected extremities, creatinine, creatine phosphokinase, management, and outcome. Results: Seventeen of 11,468 trauma patients (.148{\%}) developed SECS. Mean admission hematocrit was 31.7 ± 8.9, mean admission base deficit was -13.3, mean worst base deficit was -17.8, and average Injury Severity Score was 36.3 ± 16.6. Patients received 20.9 ± 11.0 units of blood and 24.6 ± 14 L of crystalloid prior to the development of SECS. Average time from admission to diagnosis of the SECS was 32.6 hours. Acute renal failure developed in 6 (35{\%}) patients; 4 required dialysis, and 3 died. The number of affected extremities ranged from 1 to 4. Of the 46 affected extremities, 39 were salvaged and 7 required amputation. Mortality was 35.3{\%}. Conclusions: SECS is an uncommon, but devastating complication in severely injured patients with hypotension undergoing massive transfusion, and developing systemic inflammatory response syndrome. Vigilance increases detection. While the overall mortality was reduced by half, patients requiring dialysis have a 75{\%} mortality.",
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AU - Wyrzykowski, Amy D.

AU - MacLeod, Jana B A

AU - Wise, Kevin B.

AU - Dente, Christopher J.

AU - Salomone, Jeffrey P.

AU - Nicholas, Jeffrey M.

AU - Vercruysse, Gary -

AU - Ingram, Walter L.

AU - Rozycki, Grace S.

AU - Feliciano, David V.

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N2 - Background: In 2002, our institution published a 5-year retrospective review of 10 patients who developed secondary extremity compartment syndrome (SECS) with a mortality rate of 70%. Since then, we have aggressively screened for the development of SECS in high-risk patients. We postulate that awareness of SECS and vigilant monitoring for its development would result in earlier diagnosis and treatment and improved outcome. Methods: Retrospective review of all patients at a level I trauma center developing SECS from 2002 to 2006. Data collected included demographics, mechanism of injury, injury complex, blood transfused prior to development of SECS, affected extremities, creatinine, creatine phosphokinase, management, and outcome. Results: Seventeen of 11,468 trauma patients (.148%) developed SECS. Mean admission hematocrit was 31.7 ± 8.9, mean admission base deficit was -13.3, mean worst base deficit was -17.8, and average Injury Severity Score was 36.3 ± 16.6. Patients received 20.9 ± 11.0 units of blood and 24.6 ± 14 L of crystalloid prior to the development of SECS. Average time from admission to diagnosis of the SECS was 32.6 hours. Acute renal failure developed in 6 (35%) patients; 4 required dialysis, and 3 died. The number of affected extremities ranged from 1 to 4. Of the 46 affected extremities, 39 were salvaged and 7 required amputation. Mortality was 35.3%. Conclusions: SECS is an uncommon, but devastating complication in severely injured patients with hypotension undergoing massive transfusion, and developing systemic inflammatory response syndrome. Vigilance increases detection. While the overall mortality was reduced by half, patients requiring dialysis have a 75% mortality.

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