Factors Associated with Development of Traumatic Acute Compartment Syndrome: A Systematic Review and Meta-analysis

Background: Acute compartment syndrome (ACS) is a devastating condition, further aggravated by delayed diagnosis.Since ACS is a clinical diagnosis, identification of risk factors for individual patients may help with earlier detection. Thisstudy aims to identify the risk factors associated with the development of ACS of the extremities.Methods: We performed a systematic review and meta-analysis of studies with adult patients at risk for and withtraumatic ACS of the extremity. Non-traumatic, chronic exertional, vascular and abdominal compartment syndromewere excluded. Technical reports, biomechanical studies, abstracts, studies of non-human subjects, non-Englishstudies, and studies with less than five subjects were excluded. Meta-analysis was performed on a subset of studiesincluding a control group. We addressed cases of substantial heterogeneity among the studies with subgroup analysis,and whenever heterogeneity remained significant, we employed random effect meta-analysis for the data pooling. Thestudy protocol has been registered in PROSPERO (ID = CRD۴۲۰۱۹۱۲۶۶۰۳).Results: There were ۱۹ studies with ۴۸,۸۸۷ patients investigating risk factors of traumatic ACS. Of these, therewere ۱,۷۱۶ patients with the diagnosis of traumatic ACS. Fourteen studies (۴۶,۳۰۰ controls and ۱,۳۵۸ ACS patients)qualified for meta-analysis. Male to female ratio was ۵.۵ with an average age of ۳۶ years. Factors that were significantlyassociated with the development of ACS were: age ۱۸-۶۴ (OR: ۱.۳۴, ۹۵% CI: ۱.۰۷-۱.۶۸), male (OR: ۲.۱۸, ۹۵% CI:۱.۵۳-۳.۱۰), gunshot wound with fracture and vascular injury (OR: ۱۲.۵, ۹۵% CI: ۵.۶۹-۲۷.۴۶), combined forefoot andmidfoot injury (OR: ۳.۳, ۹۵% CI: ۲.۳۹-۴.۵۷), injury severity score (ISS) ۰-۹ (OR: ۱.۵۸, ۹۵% CI: ۱.۲۷-۱.۹۷), OTA/AO typeC fractures (OR: ۲.۷۵, ۹۵% CI: ۱.۰۴-۷.۲۸), vascular injury (OR: ۹.۰۵, ۹۵% CI: ۶.۶۹-۱۲.۲۶), and high-energy trauma(OR: ۳.۱۰, ۹۵% CI: ۱.۶۰-۵.۸۲). Factors such as tibia fracture and crush injury were reported but were not included inquantitative analysis, due to lack of control groups and/or only one study qualifying for meta-analysis.Conclusion: This study reports on the current significant risk factors for developing traumatic ACS. The most commonrisk factors included age, sex, gunshot wound with a vascular injury, OTA/AO fracture type C and high-energy trauma.Level of evidence: II

Keywords:

acute disease , Adult , Compartment syndromes/diagnosis , Compartment syndromes/surgery , Humans , Risk Assessment