Is Perfusion Pressure a Better Tool to Diagnose Abdominal Compartment Syndrome?
Sophia Abdulhai, MD; Bricey Kepnes, B.S.; Raghavendra Rao, MD; Micheal Forbes MD; Neil McNinch, MS RN; Mark McCollum, MD
Akron Children's Hospital, Akron, OH
Background: Pressure gradients, rather than absolute compartment pressures, are used to identify organ hypoperfusion throughout the body (i.e. cerebral perfusion pressure and delta-P in extremities), as they are more sensitive and specific in diagnosing compartment syndromes resulting in decreased frequency of highly morbid and invasive decompression procedures. This study explores if this is also true in the diagnosis of abdominal compartment syndrome (ACS) in pediatric patients.
Methods: A retrospective chart review was performed on pediatric patients with at least one bladder pressure (BLP) measured during their ICU stay from 2012-2017. Perfusion pressure (delta-p) was calculated using BLP and diastolic blood pressure (DP).
BLP and delta-P before the diagnosis of ACS (those with evidence of organ malperfusion who required decompression) and the lowest and highest BLP and delta-P in those who did not develop ACS were compared for their diagnostic ability in determining ACS using ROC curves.
Results: Of the 96 included patients, 23 (24%) developed ACS. Mean age was 5.8 (0-17 years). BLP and delta-P were equally diagnostic of ACS (p=0.76). The area under the curve (AUC) for BLP was 0.730, with a pressure of 18 resulting in the highest overall sensitivity and specificity (73.9% and 63.5%, respectively). For delta-P, AUC was 0.753, with a pressure of 28 having the overall highest sensitivity of 82.6% and specificity of 54.1%.
Conclusion: While delta-P was not found to be a better diagnostic tool in our data for ACS, this study gives additional threshold values of when to suspect ACS in pediatric patients.
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