Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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A predictive nomogram-based model for lower extremity compartment syndrome after trauma in the United States: a retrospective case-control study

  • Blake Callahan (Department of Surgery, University of Central Florida College of Medicine) ;
  • Darwin Ang (Department of Surgery, University of Central Florida College of Medicine) ;
  • Huazhi Liu (Department of Surgery, HCA Ocala Hospital)
  • Received : 2024.10.16
  • Accepted : 2024.03.14
  • Published : 2024.06.30
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Abstract

Purpose: The aim of this study was to utilize the American College of Surgeons Trauma Quality Improvement Program (TQIP) database to identify risk factors associated with developing acute compartment syndrome (ACS) following lower extremity fractures. Specifically, a nomogram of variables was constructed in order to propose a risk calculator for ACS following lower extremity trauma. Methods: A large retrospective case-control study was conducted using the TQIP database to identify risk factors associated with developing ACS following lower extremity fractures. Multivariable regression was used to identify significant risk factors and subsequently, these variables were implemented in a nomogram to develop a predictive model for developing ACS. Results: Novel risk factors identified include venous thromboembolism prophylaxis type particularly unfractionated heparin (odds ratio [OR], 2.67; 95% confidence interval [CI], 2.33-3.05; P<0.001), blood product transfusions (blood per unit: OR 1.13 [95% CI, 1.09-1.18], P<0.001; platelets per unit: OR 1.16 [95% CI, 1.09-1.24], P<0.001; cryoprecipitate per unit: OR 1.13 [95% CI, 1.04-1.22], P=0.003). Conclusions: This study provides evidence to believe that heparin use and blood product transfusions may be additional risk factors to evaluate when considering methods of risk stratification of lower extremity ACS. We propose a risk calculator using previously elucidated risk factors, as well as the risk factors demonstrated in this study. Our nomogram-based risk calculator is a tool that will aid in screening for high-risk patients for ACS and help in clinical decision-making.

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Acknowledgement

The authors received no financial support for this study.

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