509 Diagnosing Paediatric Compartment Syndrome and Its Challenges

Abstract

Abstract Aim to conduct a critical analysis of current published evidence and key papers in relation to diagnosing paediatric compartment syndrome. Method A thorough literature search was conducted using databases including Pubmed, Cochrane central register, Medline and google scholar. Specific eligibility criteria was applied to studies within the last 20 years to incorporate post neonatal paediatric patients till the age of 16 with a high clinical suspicion of limb compartment syndrome presenting acutely. Results There is an overall good literature overview in diagnosing paediatric compartment syndrome and a general consensus in assessing agitation, anxiety and increasing use of analgesia as the 3A's for clinical diagnosis. Several studies recommend measuring delta P by subtracting compartment pressure from diastolic blood pressure. The majority of evidence is level IV and level V as pressure monitoring in children is challenging and user dependent. Literature fails to agree on a cut off for emergency fasciotomy using pressure monitoring and there is limited evidence to validate normal paediatric compartment pressures. Non-invasive compartment pressure monitoring such as near infrared spectroscopy, pulse phase locked loop ultrasound and mechanical myotonometry is currently being researched. Conclusions Compartment syndrome is an orthopaedic emergency requiring emergency fasciotomy in theatre. It is primarily a clinical diagnosis however there is lack of a validated diagnostic test in paediatric patients due to limitations of using needle manometry in an upset child. There is a need for an evidence-based database with further research to determine the extent of pressure monitoring in children identifying normal versus abnormal compartment pressures.