TY - JOUR
T1 - Defining Incidence of Acute Compartment Syndrome in the Research Setting
T2 - A Proposed Method from the PACS Study
AU - METRC
AU - Leroux, Andrew
AU - Frey, Katherine P.
AU - Crainiceanu, Ciprian M.
AU - Obremskey, William T.
AU - Stinner, Daniel J.
AU - Bosse, Michael J.
AU - Karunakar, Madhav A.
AU - O-Toole, Robert V.
AU - Carroll, Eben A.
AU - Hak, David J.
AU - Hayda, Roman
AU - Alkhoury, Dana
AU - Schmidt, Andrew H.
AU - Hsu, Joseph R.
AU - Seymour, Rachel B.
AU - Sims, Stephen H.
AU - Churchill, Christine
AU - Stahel, Philip F.
AU - Trujillo, Corey Henderson
AU - Westberg, Jerald R.
AU - Di, Junrui
AU - Boulton, Christina L.
AU - Costales, Timothy G.
AU - Dubina, Andrew G.
AU - Eglseder, W. Andrew
AU - LeBrun, Christopher T.
AU - Manson, Theodore T.
AU - Nascone, Jason W.
AU - Pensy, Raymond A.
AU - Sciadini, Marcus F.
AU - Degani, Yasmin
AU - Holmes, Amanda C.
AU - Boyce, Robert H.
AU - Burgos, Eduardo J.
AU - Evans, Jason M.
AU - Gajari, Vamshi
AU - Jahangir, A. Alex
AU - Mir, Hassan
AU - Perdue, Aaron
AU - Rodriguez-Buitrago, Andres
AU - Sethi, Manish K.
AU - Tummuru, Rajesh R.
AU - Goodman, James Brett
AU - Holden, Martha B.
AU - Castillo, Renan C.
AU - MacKenzie, Ellen J.
AU - Allen, Lauren
AU - Carlini, Anthony R.
AU - Collins, Susan C.
N1 - Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Objective: To compare the retrospective decision of an expert panel who assessed likelihood of acute compartment syndrome (ACS) in a patient with a high-risk tibia fracture with decision to perform fasciotomy. Design: Prospective observational study. Setting: Seven Level 1 trauma centers. Patients/Participants: One hundred eighty-two adults with severe tibia fractures. Main Outcome Measurements: Diagnostic performance (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver-operator curve) of an expert panel's assessment of likelihood ACS compared with fasciotomy as the reference diagnostic standard. Secondary Outcomes: The interrater reliability of the expert panel as measured by the Krippendorff alpha. Expert panel consensus was determined using the percent of panelists in the majority group of low (expert panel likelihood of ≤0.3), uncertain (0.3-0.7), or high (>0.7) likelihood of ACS. Results: Comparing fasciotomy (the diagnostic standard) and the expert panel's assessment as the diagnostic classification (test), the expert panel's determination of uncertain or high likelihood of ACS (threshold >0.3) had a sensitivity of 0.90 (0.70, 0.99), specificity of 0.95 (0.90, 0.98), PPV of 0.70 (0.50, 0.86), and NPV of 0.99 (0.95, 1.00). When a threshold of >0.7 was set as a positive diagnosis, the expert panel assessment had a sensitivity of 0.67 (0.43, 0.85), specificity of 0.98 (0.95, 1.00), PPV of 0.82 (0.57, 0.96), and NPV of 0.96 (0.91, 0.98). Conclusion: In our study, the retrospective assessment of an expert panel of the likelihood of ACS has good specificity and excellent NPV for fasciotomy, but only low-to-moderate sensitivity and PPV. The discordance between the expert panel-assessed likelihood of ACS and the decision to perform fasciotomy suggests that concern regarding potential diagnostic bias in studies of ACS is warranted.
AB - Objective: To compare the retrospective decision of an expert panel who assessed likelihood of acute compartment syndrome (ACS) in a patient with a high-risk tibia fracture with decision to perform fasciotomy. Design: Prospective observational study. Setting: Seven Level 1 trauma centers. Patients/Participants: One hundred eighty-two adults with severe tibia fractures. Main Outcome Measurements: Diagnostic performance (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver-operator curve) of an expert panel's assessment of likelihood ACS compared with fasciotomy as the reference diagnostic standard. Secondary Outcomes: The interrater reliability of the expert panel as measured by the Krippendorff alpha. Expert panel consensus was determined using the percent of panelists in the majority group of low (expert panel likelihood of ≤0.3), uncertain (0.3-0.7), or high (>0.7) likelihood of ACS. Results: Comparing fasciotomy (the diagnostic standard) and the expert panel's assessment as the diagnostic classification (test), the expert panel's determination of uncertain or high likelihood of ACS (threshold >0.3) had a sensitivity of 0.90 (0.70, 0.99), specificity of 0.95 (0.90, 0.98), PPV of 0.70 (0.50, 0.86), and NPV of 0.99 (0.95, 1.00). When a threshold of >0.7 was set as a positive diagnosis, the expert panel assessment had a sensitivity of 0.67 (0.43, 0.85), specificity of 0.98 (0.95, 1.00), PPV of 0.82 (0.57, 0.96), and NPV of 0.96 (0.91, 0.98). Conclusion: In our study, the retrospective assessment of an expert panel of the likelihood of ACS has good specificity and excellent NPV for fasciotomy, but only low-to-moderate sensitivity and PPV. The discordance between the expert panel-assessed likelihood of ACS and the decision to perform fasciotomy suggests that concern regarding potential diagnostic bias in studies of ACS is warranted.
KW - Acute compartment syndrome
KW - Expert panel
KW - Negative predictive value
KW - Positive predictive value
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U2 - 10.1097/BOT.0000000000002284
DO - 10.1097/BOT.0000000000002284
M3 - Article
C2 - 34924516
AN - SCOPUS:85122324479
SN - 0890-5339
VL - 36
SP - S26-S32
JO - Journal of orthopaedic trauma
JF - Journal of orthopaedic trauma
ER -