Development of a Handheld Ultrasound-Based System to Assist in Clinical Diagnosis of Acute Compartment Syndrome
Abstract
Objectives and Rationale: Acute Compartment Syndrome (ACS) is a severe complication following limb trauma resulting from accidents in civilian settings and injuries on the battlefield. ACS needs to be diagnosed and treated quickly to avoid loss of limb. ACS develops when pressure builds up inside an enclosed muscle space, known as a compartment, resulting in a cut-off of blood circulation to muscles and nerves. This, in turn, can lead to cell death and ultimately loss of muscle use. Muscle compartments in the arms and legs are particularly susceptible to ACS following trauma such as a fractured bone, where muscle compartment pressure rises due to internal bleeding and swelling of the tissue. All muscles are encased by a non-elastic connective tissue called fascia. When pressure is elevated in the muscle, the connective tissue encasing it – fascia – bulges as a result and takes on a convex shape (curves outward). The proposed project builds on previously published work completed by our Principal Investigator (PI) and Co-PI using a simple, yet novel non-invasive approach to indirectly measure the pressure in the muscle compartment. Using ultrasound imaging combined with a pressure sensor, a measurement of how much external pressure must be applied to the limb in order to flatten the bulging fascia (flatten the outward curve) is obtained. Cadaver studies with simulated elevated compartment pressure, as well as clinical injured and non-injured patient studies have shown a clear correlation between the amount of external pressure required to flatten the fascia and the internal pressure within the compartment. The current gold standard in diagnosing ACS is insert a large-gauge needle into multiple muscle compartments and invasively measure pressure. This is done for each compartment (there are four muscle compartments in the leg, for example), and multiple times (to determine trends in rise of pressure). This highly invasive test is very painful, but also highly inaccurate, leading to its infrequent use by physicians. The objective of this study is to develop and test an automated operator-independent, non-invasive, handheld device that implements the proposed method of measuring elevated compartment pressure to assist in diagnosing ACS both in a civilian setting and on the battlefield. PRORP CTRA Focus Area to be Addressed: With its novel, non-invasive indirect approach to measuring muscle compartment pressure, this study directly addresses the Clinical Translational Research Award Focus Area of “Compartment Syndrome: Novel treatment strategies to improve current diagnoses for compartment syndrome. Alternatives to intra-compartmental pressure measurements are encouraged.” What Types of Patients Will It Help and How Will It Help Them? The proposed device will help all patients, military and civilian, that are inflicted by a traumatic injury and either develop ACS or are suspected of developing ACS. In the military, this device will have a role throughout the casualty evacuation chain and management of Soldiers with limb injuries, from point-of-injury triage to field care, evacuation care, and emergency medical facility care. For both military and civilian patients, a prompt diagnosis results in a faster and more complete recovery, providing a higher chance of maintaining full functionality of the limbs and a return to full duty. Short- and/or Long-Term Impact on Patient Care: The impact of the proposed device will be felt on a systems level by reducing the cost of unnecessary referrals and hospitalizations and on a patient level by reducing unnecessary fasciotomies (the surgical procedure of cutting open the entire length of the patient’s muscle fascia in order to release compartment pressure), with their high complication rate. Critically, the proposed device will aid in the early detection and treatment of ACS with its risk of loss of function and limb (amputation). The operator-independency of th
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110767
Entities
People
- Safa Herfat
Organizations
- United States Army