The Use of Near Infrared Spectroscopy in the Diagnosis of Acute Compartment Syndrome in Trauma Patients (NIRS)

Adults who have sustained major blunt and penetrating trauma, who present to Grady Memorial Hospital, Atlanta Medical Center, or Athens Regional Medical Center for treatment meeting the inclusion and exclusion

Inclusion Criteria:

• 18-60 years of age
• Admitted to a participating trauma center (Grady, AMC, ARMC) within 12 hours of injury
• At least one uninjured upper extremity

• Patients enrolled in Cohort 2 will have a "severe leg injury" (must be one of the following locations and MOI):

  1. Anatomic Location:

• Tibia/fibula shaft fracture
• Tibial plateau fracture (Schatzker III-VI) 2. High Energy Mechanism of Injury (MOI):
• Fall from >8 foot height
• Motor vehicle collision (>15mph)
• Motor vehicle versus pedestrian accident
• High velocity gunshot wound
• Crush injury
• Sport/recreation

• Patients enrolled in Cohort 1 will meet the criteria listed below:

  1. No bony or vascular lower extremity injury (including femur or foot fractures)
  2. Admitted to the ICU for a traumatic injury (not a medical problem, such as a heart attack)
  3. ICU stay for at least 48 hours(patients with < 2 hours of data will be excluded)

Patients will also be selected for each cohort (See Groups/Cohorts Section).

Exclusion Criteria:

• NIRS monitoring impediment to care
• Known prior leg fractures (not related to current injury)
• Peripheral vascular disease history or concurrent lower extremity vascular injury/surgery
• Admission for medical reasons - atraumatic (ie. myocardial infarction, sepsis…)
• Less 18 years old or greater than 60 years old
• Unable to provide informed consent, or consent cannot be obtained from a legally authorized representative, within 12 hours of injury or prior to first leg surgery, whichever comes first
• Amputation/Mangled Lower Extremity
• Previous fasciotomy history of the injured leg prior to enrollment
• Complete spinal cord injuries
• Bilateral upper extremity injuries
• Participants who are in custody at presentation to the hospital
• Pregnancy

• Open injury on the injured leg that is large enough that at least one NIRS sensor cannot be safely placed over the compartment

  • Spanish-speaking subjects who do not speak English will NOT be excluded. A certified translated copy of the informed consent document will used and a translator will be present for Spanish-speaking patients.