Pediatric acute compartment syndrome: a systematic review and meta-analysis

Acute compartment syndrome (ACS) is an emergency with potentially devastating consequences. Delayed recognition may be especially concerning for the pediatric population, as children present with a wide variety of etiologies, symptoms, and levels of communication. We sought to determine the average time from injury to diagnosis, most common presentations, the degree to which providers obtained pressure measurements, and outcomes of ACS in the pediatric population. We performed a systematic review of multiple databases to include English-language clinical studies reporting ACS of the extremity in pediatric patients. Review articles, studies lacking statistical data, single case reports, and other evidence level V studies were excluded. Twelve studies were included, with all reporting clinical outcomes following diagnosis and intervention of ACS in children. There were 233 children with an average age of 9.7 years (SD: 5.9 years, range: 0-18 years). The most common causes were trauma-related: pedestrian versus motor vehicles (21%), motor vehicle accidents (12%), falls (12%), and sports/exercise-related injuries (12%). ACS occurred in all extremities, with lower leg (60%) and forearm (27%) being most common. Seventy-five percent of patients had concomitant fractures. Compartment pressures were measured in 68% of patients to aid diagnosis. Pain was the most common presenting symptom (88%) followed by paresthesias (32%). The mean time from injury to fasciotomy was 25.4 h. Patients had good outcomes, with 85% achieving full functional recovery. Range of motion deficit (10%) was the most common complication. We detected no significant difference in time from injury to fasciotomy, age, sex, the presence of a fracture, or anatomic location in those patients who achieved full functional recovery compared with patients who did not. Pediatric ACS occurs most often in the setting of trauma. Intracompartmental pressure measurements can aid diagnosis. Pediatric ACS differs from adult ACS, as pediatric patients generally achieve good outcomes even when presenting in delayed fashion and undergoing fasciotomies for at least 24 h. We recommend considering decompressive fasciotomy in children even if there is prolonged time from injury to diagnosis. Level of evidence: IV.