Association of trauma severity scores with limb amputation and death in acute leg compartment syndrome
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ORIGINAL ARTICLE
Association of trauma severity scores with limb amputation and death in acute leg compartment syndrome Dafang Zhang1,2 · Matthew Tarabochia2,3 · Arvind von Keudell1,2 Received: 27 September 2020 / Accepted: 15 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose Limb amputation and death are devastating sequelae of acute compartment syndrome (ACS), and have been posited to result either from the initial injury burden or from pathophysiologic sequelae, such as rhabdomyolysis leading to acute renal failure. We aimed to test the hypothesis that severity of trauma is associated with limb amputation and death in patients with traumatic leg ACS. Methods We retrospectively reviewed 302 patients with ACS of 302 legs treated with fasciotomies from 2000 to 2015 at two tertiary trauma centers. Our response variables were death and limb amputation during inpatient hospital admission. Three common trauma severity scores, injury severity score (ISS), revised trauma score (RTS), and Glasgow coma scale (GCS), were studied. Patient- and injury-related explanatory variables were studied. Bivariate analyses were used to identify factors associated with limb amputation and death. Results Of 302 patients, 13 (4%) underwent limb amputation and 10 (3%) died during the inpatient admission. Only one of 10 patients who expired died secondary to acute renal failure. ISS and GCS were significantly associated with limb amputation, and RTS was marginally associated. ISS, RTS, and GCS were significantly associated with death. Moreover, smoking and open fracture were significantly associated with limb amputation, and diabetes mellitus, presence of fracture, closed head injury, and chest or abdominal injury were associated with death. Conclusion Trauma severity scores are associated with both limb amputation and death during inpatient admission for traumatic leg ACS. These adverse sequelae of leg ACS are likely driven by the initial injury burden. Keywords Cute compartment syndrome · Injury severity score · Revised trauma score · Glasgow coma scale · Fasciotomy · Leg
Introduction Acute compartment syndrome is a disorder of increased intra-compartmental pressure leading to decreased tissue perfusion, and if untreated, irreversible tissue necrosis. Delayed recognition or delayed treatment of acute compartment syndrome can result in irreversible ischemia and necrosis of intra-compartmental tissues, including muscles
* Dafang Zhang [email protected] 1
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
2
Harvard Medical School, Boston, MA 02115, USA
3
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
and nerves, with resultant contracture and/or neurologic dysfunction that can limit limb function [1, 2]. The treatment for acute compartment syndrome is prompt diagnosis and decompressive fasciotomy [3]. Acute compartment syndrome often results from trauma and most commonly affects
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