Assessment of Near Infrared Spectroscopy as a Diagnostic Tool in Acute Compartment Syndrome
Condition: Compartment Syndrome
MeSH terms: Compartment Syndromes; Syndrome
Study type: Observational

Summary: 
      The purpose of this study is to define the reliability and accuracy of Near Infrared
      Spectroscopy (NIRS) in the detection of intra-compartmental tissue perfusion in injured and
      noninjured extremities over time. We hypothesize that this technology, combined with vital
      signs, intracompartmental pressures and clinical examinations, will be useful in diagnosing
      acute compartment syndrome (ACS), monitoring patients at risk for ACS, and evaluating the
      adequacy of fasciotomy in patients treated for ACS.
    

Detailed description: 
      Acute compartment syndrome (ACS) is associated with lower leg trauma in up to 20% of high
      energy injuries. ACS occurs when the pressure due to swelling exceeds the perfusion pressure
      thereby cutting off blood flow to the leg. If untreated, the results can be catastrophic with
      an insensate, contracted leg. Moreover, there is a high risk of subsequent infection and even
      amputation. The treatment for ACS, a four compartment fasciotomy, is aimed at releasing the
      pressure through two incisions from roughly the knee to the ankle. Often due to wound
      expansion, the incisions require multiple debridements and skin grafting to close. With
      fasciotomies, fractures are converted from closed to open injuries. When left open for many
      days, the risk of infection and complications such as nonunion increase significantly.

      The only accepted objective method for diagnosis of ACS is to measure the pressure inside the
      leg compartments by using a large gauge needle hooked to a pressure monitor. However, these
      readings can be erroneous if not performed correctly. As such, ACS continues to be a clinical
      diagnosis which is made based on the surgeon's experience and their interpretation of the
      character of the injury (high-energy, motorcycle crash, vs. low-energy, a twisted ankle).
      Clinicians are left to attempt to interpret physical exam findings and readings from pressure
      monitors. Most importantly ACS is not an event, but a process that can manifest at multiple
      points after injury. The most accurate and effective method for diagnosing and appropriately
      treating ACS is serial examination over a course of hours to days.

      With this study, we hope to evaluate the NIRS device, which is non-invasive, as diagnostic
      tool in the evaluation of acute compartment syndrome. We plan to evaluate all patients by the
      gold standard in diagnosing acute compartment syndrome while simultaneously evaluating the
      patient with the NIRS device. This will allow us to determine if the NIRS device can
      accurately and reliably predict the development of acute compartment syndrome in a
      non-invasive, longitudinal manner.

      "Access to a precise, reliable, and noninvasive method for early diagnosis of ACS would be a
      landmark achievement in orthopaedic and emergency medicine."
    

Intervention name(s): near-infrared spectroscopy
Intervention type(s): Device
Intervention description(s): Non-invasive monitoring device applied on the surface of the skin that emits harmless red light to measure tissue perfusion.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All Patients admitted to Grady with Unilateral Lower leg injury at risk for compartment
        syndrome
      
Keywords: All Patients admitted to Grady Memorial Hospital with Unilateral Lower leg injury at risk for compartment syndrome