What is the best way to diagnose compartment syndrome?
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Clinical examination is not a reliable way to diagnose acute compartment syndrome (ACS), although the absence of pain, paresis, and paresthesia certainly rules it out. (SOR: A, based on a meta-analysis.) As a practical matter, patients with injuries serious enough to develop ACS often cannot be examined adequately anyway. (SOR: B, based on a cohort study.) Measurement of differential pressure (denoted as Δp, the diastolic blood pressure minus the absolute compartment pressure) with Δp <30 mmHg is the gold standard for diagnosis of ACS. (SOR: C, based on expert opinion.) The absolute compartment pressure (ACP) is not a reliable substitute for Δp. (SOR: B, based on a diagnostic cohort study.)
Evidence Based Practice 14(2): 11.