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Title: Intramuscular pH as a novel diagnostic tool for Acute Compartment Syndrome: A prospective clinical study.
Author: Elliott, Kirsten G. B.
ISNI:       0000 0001 3445 0374
Awarding Body: University of Aberdeen
Current Institution: University of Aberdeen
Date of Award: 2007
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Acute compartment syndrome (ACS) is a surgical emergency, which ifnot recognised and treated early, can lead to significant morbidity and even death. Currently, the diagnosis ofACS is dependent on clinical evaluation and intra-compartmental pressure monitoring. Reports in the literature regarding their accuracy and interpretatio~have been variable, resulting in low confidence amongst clinicians as to . their diagnostic power. The treatment ofACSby fasciotomies is well established, with good results when performed early. Skeletal muscle pH is a more direct measure oftissue compromise, and therefore, could provide a reliable, early warning system for diagnosing ACS. . The pilot study included 39 patients undergoing lower limb surgery requiring the use ofa thigh tourniquet. The pH monitoring equipment selected for use in this study was easy to use, acceptable to, patients with no resultant complications, and as predicted, skeletal muscle pH decreased following tourniquet inflation and recovered to baseline values upon release ofthe tourniquet. Sixty two patients at risk of, or with evidence ofACS p~cipatedin the trauma study. All underwent intra-compartmental pressure and pH monitoring for at least 24 hours following admission to hospital. Muscle biopsies were taken from a subset of the patients who underwent a surgical procedure to tr~at their injuries and were analysed in the laboratory with standard biochemical tests. Patients were followed up at specific research clinics for up to a year to assess the. injured limbs for clinical signs ofa 'missed' compartment syndrome. Demographic and injury related data were analysed as to their effect on the development ofACS and the worst levels ofpressure and pH variables recorded. Standard statistical analysis was carried out using SPSS for Windows, using parametric tests for normally distributed data, and non-parametric tests for data which was skewed. The sample ofpatients involved in this study was comparable to those seen in other studies in this research arena. No demographic or injury related factor was significantly associated with the worst levels.()fmonitored variables, or the subsequent development ofACS. The difference in pH readings between the ACS group and those with no evidence ofthe syndrome was highly significant (p<0.001). The only currently quoted pressure variable to be significantly associated with the development ofACS was an absolute pressure ofgreater than 50mmHg (p<0.02). In terms ofdiagnostic accuracy, intra~ompartmenta1pH significantly outperformed all pressure variables with an area under the Receiver Operator Characteristic curve of ,' 0.921 (best =1), compared with 0.732 for absolute pressure, and 0.591 for delta pressure. Even the initial recorded value ofpH (area under curve=0.761) performed better than either pressure variable. This identified a 'critical pH' level ofless than 6.38, which was 95% sensitive and 80% specific, far superior to any ofthe pressure variables tested. Using skeletal muscle pH as a diagnostic tool for ACS clinicians will significantly improve their hit-rate in diagno~ingACS, therefore reducing the incidence oflong tenn disabilities following the syndrome and avoiding the morbidity offasciotomies in those patients who do not require them.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available