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Secondary Abdominal Compartment Syndrome After Severe Extremity Injury: Are Early, Aggressive Fluid Resuscitation Strategies to Blame?

Madigan, Michael C. MD; Kemp, Clinton D. MD; Johnson, J Chad MD; Cotton, Bryan A. MD

The Journal of Trauma: Injury, Infection, and Critical Care: February 2008 - Volume 64 - Issue 2 - p 280-285
doi: 10.1097/TA.0b013e3181622bb6
Original Articles

Introduction: Secondary abdominal compartment syndrome (ACS) is the development of ACS in the absence of abdominal injury. The development of secondary ACS has been viewed by some authors as an unavoidable sequela of the aggressive crystalloid resuscitation often employed in the treatment of severe shock. We hypothesized that poor resuscitation techniques, including early and excessive crystalloid administration, places patients with extremity injuries at risk for developing secondary ACS.

Methods: The Trauma Registry of the American College of Surgeons database was queried for all patients with an extremity Abbreviated Injury Scale (AIS) score of 3 or greater and abdominal AIS score of 0 treated at our institution between January 1, 2001 and December 31, 2005. The study group included those patients who developed secondary ACS, whereas the comparison cohort included those who did not develop secondary ACS.

Results: Forty-eight patients developed secondary ACS and were compared with 48 randomly selected patients who had an extremity AIS score of 3 or greater and an abdomen AIS score of 0. There were no differences between the groups with respect to age, sex, race, or individual AIS scores. However, the secondary ACS group had a slightly higher Injury Severity Score (25.6 vs. 21.4, p = 0.02), significantly higher operating room crystalloid administration (9.9 L vs. 2.7 L, p < 0.001), and more frequent use of a rapid infuser (12.5% vs. 0.0%, p = 0.01). Multiple logistic regression identified prehospital and emergency department crystalloid as predictors of secondary ACS.

Conclusions: Aggressive resuscitation techniques, often begun in the prehospital setting, appear to increase the likelihood of patients with severe extremity injuries developing secondary ACS. Early, large volume crystalloid administration was the greatest predictor of secondary ACS.

From the Department of Surgery, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee.

Submitted for publication July 27, 2007.

Accepted for publication November 14, 2007.

The authors of this article have no financial or other conflicts of interest.

Presented as a poster at the 66th Annual Meeting of the American Association for the Surgery of Trauma, September 27–29, 2007, Las Vegas, Nevada.

Address for reprints: Bryan A. Cotton, MD, VUMC-Trauma, 1211 21st Avenue South, 404 Medical Arts Bldg., Nashville, TN 37212; email:

© 2008 Lippincott Williams & Wilkins, Inc.