Compartment Pressure Testing – Audit 2015

Chronic Exertional Compartment Syndrome (CECS) is a frequent occurrence in athletes, and the treatment is often surgical. Inconclusive pressure test results may cause (in both the athlete and referring practitioner) unnecessary anxiety and indecision in further management.

Measurement

In 2012/2013, a review of CECS cases revealed a few inconclusive test results. Compartment pressures were measured using the Kodiag device, sampling pressures from the anterior and deep posterior compartments of the lower limbs. I looked at whether my 2014/2015 cases had revealed a similar number of uncertain results.

Standard set

• 3% of my cases tested in 2012 resulted in an uncertain diagnosis following compartment pressure testing.
• 75% were positive and 22% were negative.
• 3% was therefore taken as a reasonable standard for subsequent tests.

Preparation

I compared retrospectively, the number of positive, negative and uncertain cases tested in Jan-Dec 2012 with those tested in Jan 2014-March 2015.

Results

36 patients were tested in 2012, and 27 patients from Jan 2014-March 2015.

• 3% ( 1/36 ) were inconclusive in 2012, and the more recent cases showed.
• 7% ( 2/27 ) were inconclusive.
• 70% (19/27) were positive, and 23% ( 6/27 ) were negative.

Conclusion

Although fewer cases were tested in 2014/2015 compared with 2012, a slightly greater percentage ( only one case, however ) were found to have an inconclusive test result. The fewer cases tested in the last year may reflect the fewer patients seen in 2014-2015. Perhaps a figure of less than 10% uncertainly is actually quite encouraging.

Recommendations for 2015/2016 – repeat audit next year

I have decided to delay compartment pressure testing in patients who have been inactive due to symptoms. I now ask my secretary to encourage patients to return to impact activities well before testing. BUPA in particular no longer adequately pay for these tests, so fewer tests are likely in 2015/2016. I’ll encourage patients to wait a little longer (months, if necessary, depending on symptoms) before undergoing these tests, in order to keep the inconclusive rate low.

- Dr Stephen Motto