SLR - April 2014 - Whitney Ellis
Reference: Duro C, Sitzman T, O’Toole R. Can Intramuscular Glucose Levels Diagnose Compartment Syndrome? J Trauma Acute Care Surg. 2014
Scientific Literature Review
Reviewed By: Whitney Ellis, DPM
Residency Program: Temple University Hospital, Philadelphia, PA
Podiatric Relevance: Compartment syndrome can be difficult to diagnose in the clinical setting, especially in patient who are not able to undergo adequate clinical examination. Current methods rely on pressure measurements of the compartment, which can have high false-positive rates. The methods also fail to specifically identify the presence of muscle ischemia. The authors of this study investigated alternative, potentially more accurate methods for identifying compartment syndrome and the presence of intramuscular ischemia using intramuscular glucose and oxygen.
Methods: Twelve anesthetized adult mixed-sex beagles were infused with lactated Ringer’s solution with normal serum concentrations of glucose to create compartment syndrome in the craniolateral compartment of the hind leg. The contralateral leg was used as the control. For eight hours, hydrostatic pressure, oxygen tension, and glucose concentrations were recorded. Two weeks later, both compartment and control legs underwent biopsy. A blinded pathologist analyzed and reviewed the specimens.
Results: The glucose concentration and oxygen tension were significantly lower in the compartment limb that in the control limb during the first 15 minutes of creating compartment syndrome (glucose, p=0.02, oxygen, p=0.007, two tailed t-test). Intramuscular glucose concentration of less than 95 mg/dl was found to be 100 percent sensitive and 75 percent specific for the presence of compartment syndrome. Partial pressure of oxygen less than 30 mmHg was 100 percent sensitive and 100 percent specific for the presence of compartment syndrome. Compartment syndrome was confirmed by pathology in all compartment limbs.
Conclusions: Intramuscular glucose concentration and partial pressure of oxygen rapidly identified muscle ischemia with both high sensitivity and specificity after experimentally created compartment syndrome. Further testing would be valuable since this was an animal model, however, the ability to properly identify and adequately diagnose compartment syndrome rapidly using intramuscular glucose concentration and partial pressure of oxygen may help to prevent the failure to accurately diagnose compartment syndrome acutely.