Regional oximetry for diagnosing compartment syndrome: a scoping review

TL;DR

This review explores how regional oximetry, specifically using near-infrared spectroscopy, could help diagnose compartment syndrome by measuring tissue oxygen levels, though results are mixed and more research is needed.

Contribution

The study systematically evaluates the diagnostic potential of NIRS for compartment syndrome, highlighting variability and the need for standardized protocols.

Findings

NIRS showed mixed correlation with perfusion pressure and ICP in acute compartment syndrome.

Pooled analysis in chronic exertional compartment syndrome revealed lower baseline StO2 and greater exercise-induced deoxygenation compared to controls.

Device variability and patient factors like skin pigmentation affect NIRS reliability.

Abstract

Diagnosis of compartment syndrome remains challenging, as intracompartmental pressure (ICP) monitoring measures mechanical pressure rather than tissue perfusion. Near-infrared spectroscopy (NIRS) enables non-invasive, continuous assessment of tissue oxygen saturation (StO2), potentially identifying ischemia earlier. However, its diagnostic accuracy remains uncertain.

Following PRISMA-ScR guidelines, PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, and WHO-ICTRP were searched to April 2025 for studies evaluating NIRS in acute (ACS) or chronic exertional (CECS) compartment syndrome. Data on diagnostic accuracy, device protocols, and patient characteristics were extracted. Studies reporting comparable StO2 data in CECS and controls were pooled using a random-effects meta-analysis.

Twenty-three studies (n = 1000) were included. In ACS, some demonstrated strong correlation with perfusion pressure and post-fasciotomy StO2 recovery, while others found poor agreement with ICP or no diagnostic discrimination. There was heterogeneity in device type, patient demographics (particularly skin pigmentation), and protocols. In CECS, pooled analysis showed lower baseline StO2 (mean difference − 3.4%, 95% CI − 6.2 to − 0.7) and greater exercise-induced deoxygenation (+ 15.0%, 95% CI 0.4–29.7) versus controls.

NIRS provides a physiologically relevant but technically variable indicator of compartmental perfusion, which may complement, but not replace, ICP monitoring for compartment syndrome. The results presented are hypothesis-generating and require prospective trials with standardised protocols, inclusive calibration, and prospective validation before clinical adoption of NIRS.

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