Fig. 4

Flowchart depicting how the diagnosis of ACS was confirmed in the 28 patients with clinical signs of ACS who underwent fasciotomy. ICP monitoring was used only in patients with equivocal clinical signs and those intubated, sedated or obtunded. ACS was defined as pathological ICP values before fasciotomy, and/or by the presence of muscle bulging at the time of fasciotomy. When ICP was not measured (alert and collaborative patients with unequivocal clinical signs), muscle bulging had to be reported in the operative notes to confirm ACS. If muscle aspect was not described in the operative notes, the diagnosis of ACS was based on ICP measurements. The diagnosis of ACS was not confirmed if fasciotomy was performed without prior ICP measurements, and if there was no muscle bulging at the time of surgery. There was no false positive ACS diagnosis, meaning that every patient who underwent fasciotomy had pathological ICP values before fasciotomy, and/or presented muscle bulging at the time of fasciotomy. ACS: acute compartment syndrome; ICP: intra-compartmental pressure