H.3A Under Pressure: A noninvasive approach to diagnose compartment syndrome

Compartment syndrome is a medical emergency that occurs when increased pressure within a compartment compromises the circulation and function of the tissues within that space. It typically occurs in a limb after a trauma and presents as “the 5 P’s”: pain, pallor, pulselessness, paresthesias, and paralysis. Definitive treatment is via a high risk, costly surgical procedure known as a fasciotomy, where the fascia enclosing the compartment is cut and pressure is released.

Currently, diagnosis of compartment syndrome is primarily driven by clinical exam. It is rare for a patient to demonstrate all 5 P’s listed above if they have compartment syndrome. Because of this, diagnosis is very hard to make clinically and is a large pitfall to prompt management. A cohort study from the Canadian Journal of Emergency Medicine noted that patients at a hospital in Montreal who underwent fasciotomies noted a concerning “median event-to-operation” duration of a shocking 9 hours for traumatic cases (DOI:10.1017/S148180350000511X). Clinical suspicion for compartment syndrome must be very high for a surgeon to consider performing such a surgery, therefore objective measures are in place to measure compartment pressures. In general, an intracompartment pressure>30 mmHg is considered high risk and merits surgical intervention.

Hand held manometers are a portable device used to measure intracompartmental pressures however they are very invasive and require inserting a long, thick needle catheter into a space blindly. Additionally, because they are invasive, they must be used in a sterile field which consumes hospital equipment and requires more time for proper set up. 

The goal of this project is to develop a cost-effective, non or minimally invasive device that can accurately measure compartment pressures in a limb. Ideally, this device would be user friendly, and would provide a quick objective way for a surgeon to determine whether or not a patient should be operated on.  The goal would be to reduce median event to operation time as a result of fast accurate diagnosis. This could help reduce the number of invasive, costly diagnostic tests done on patients to diagnoses compartment syndrome