Massachusetts Chapter of the American College of Surgeons

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Management and Outcomes of Upper Extremity Compartment Syndrome Transfers from the Community
April Hou, MD, Rachel Lister, Aixa Perez-Coulter, MS, MPH, Aparajit Naram, MD, FACS
UMass Chan Medical School, Baystate Medical Center, Springfield, MA

Background: Compartment syndrome requires timely intervention to limit long-term morbidity; ideally within eight hours of symptom onset. Given the emergent nature, we argue that compartment syndrome is a contraindication for transfer when diagnosed in a facility with surgical capabilities. Fasciotomies of the forearm, however, are often exclusively referred to Hand surgeons. As a result, patients with upper extremity compartment syndrome are usually transferred to a tertiary center for sub-specialty consultation. These transfers may result in delays of care.
Methods: A retrospective review was performed on all adult patients treated for upper extremity compartment syndrome from January 1, 2005 to December 31, 2021. These data include the referring hospitalís surgical capabilities, the nature of the initial evaluation, timing to surgical decompression, and overall morbidity following treatment.
Results: We identified 94 patients treated, of which 35 patients were transferred from an outside hospital. The most common etiologies were prolonged dependent position (25.6%) and infection (21.4%). Compartment pressures were checked on 5.7% of patients before transfer compared to 20.3% non-transfer patients. The median time between symptoms and surgical decompression for transfer patients was 18.8 hours, and 51.9% of transfer patients had profound disability on follow-up.
Conclusion: Patients transferred from outside institutions experienced a clinically significant delay in treatment with residual disability. Additionally, many of the transfers occurred without an objective diagnosis, as demonstrated by the infrequent measurement of compartment pressures. Understanding the reasons for transfer within our community is the first step to developing interventions that could potentially eliminate detrimental transfers of care.


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