A Comparison of Two Models Predicting the Presence of Chronic Exertional Compartment Syndrome

Abstract

Clinical history and physical examination are usually not sufficient to diagnose leg chronic exertional compartment syndrome (CECS). Two predictive clinical models have been proposed. The first model by De Bruijn et al. is displayed as a nomogram that predicts the probability of CECS according to a risk score. The second model by Fouasson-Chailloux et al. combines two signs (post-effort muscle hardness on palpation or hernia). To evaluate those models, we performed a prospective study on patients who were referred for possible CECS. 201 patients underwent intra-compartmental pressure at 1-min post-exercise (CECS if ≥ 30 mmHg) – 115 had CECS. For the De Bruijn et al. model, the risk score was 7.5±2.2 in the CECS group and 4.6±1.7 in the non-CECS group (p<0.001) with an area under the ROC curve of 0.85. The model accuracy was 80% with a sensitivity of 82% and a specificity of 78%. Concerning Fouasson-Chailloux et al. model, the accuracy was 86%; the sensitivity and the specificity were 75 and 98%, respectively. The De Bruijn et al. model was a good collective model but less efficient in individual application. In patients having both muscle hardness and hernia, we could clinically make the diagnosis of CECS.

Review of Reliable and Valid Noninvasive Tools for the Diagnosis of Chronic Exertional Compartment Syndrome

“…The 25 included studies were on the following topics: MRI (n = 8), 1 , 16 , 27 , 39 , 46 , 47 , 54 , 56 NIRS (n = 6), 21 , 31 , 38 , 54 , 55 , 66 EMG (n = 4), 7 , 24 , 41 , 65 SPECT (n = 5), 15 , 23 , 32 , 50 , 52 US (n = 2), 5 , 59 MYO (n = 1), 24 and predictive clinical model (n = 1). 57 …”

“…Vignaud et al 57 studied the diagnostic accuracy of 2 predictive diagnostic models in 201 patients suspected of CECS 11 , 18 and found an accuracy of 86%, sensitivity of 75%, and specificity of 98% for the model by Fouasson-Chailloux et al 18 and an accuracy of 80% with a sensitivity of 82% and specificity of 78% for a threshold of 5.56 in the model by de Bruijn. 10 The study was classified as having a low risk of bias.…”

“…However, the currently available models are not accurate enough to replace ICP for diagnosis of CECS and aid mainly in the estimation of the risk to develop CECS. 57 …”

“… § References 1, 5, 7, 15, 16, 21, 23, 24, 27, 31, 32, 38, 39, 41, 46, 47, 50, 52, 54 –57, 59, 65, 66. …”

Systematic Review of Innovative Diagnostic Tests for Chronic Exertional Compartment Syndrome

“…For example, two studies stipulated the potential use of ultrasonography reflecting levels of ICPs 14 48 . In addition, predictive models such as nomograms or evaluation of specific pain profiles after symptom provocation might have value as an easy-to-use and noninvasive alternative to ICPM 1 38 49 . By identifying key criteria, the use of additional invasive diagnostic tests might even become unnecessary.…”