Optic nerve sheath diameter as a non-invasive indicator of intracranial hypertension in traumatic brain injury: correlation with CT head and prognostic implications (original) (raw)
Related papers
International journal of radiology and diagnostic imaging, 2021
Increased intracranial pressure (ICP) is complication of traumatic brain injury. Early detection of raised ICP is helpful in timely treatment. Bed side ultrasound of optic nerve sheath is easier for detection of raised intracranial pressure by measuring its diameter. Our aim was to determine whether bedside ultrasound measurement of optic nerve sheath diameter (ONSD) can accurately predict raised intracranial pressure in head injury patients and to calculation of validity of test. Methods and Materials: Total 150 patients with head injury was first examined by ultrasound. The ONSD was measured 3 mm behind the globe perpendicular to long axis of globe in both eyes than mean binocular ONSD was calculated. Diameter more than 5 mm was considered abnormal. CT scan was performed in all patients and result was considered positive for elevated ICP if mid line shift, effacement of sulci, ventricles and cisterns are seen. Results: Out of total 150 patients 61 was female and 89 was male, age was ranging from 23-61 years. 30 patients showed mean binocular ONSD >5mm by ultrasound out of them 26 patients showed positive signs of raised intracranial pressure on CT. Sensitivity and negative predictive value of ultrasound to detect raised ICP was 100%, Specificity was 96.7 % and negative predictive value was 86.6 %. Conclusions: Ultrasound can be used as bed side screening tool to detect raised ICP in ICU patients and head trauma patients especially in hospital with high patient flow in emergency department.
Surgical Neurology International, 2019
Background: Measurement of optic nerve sheath diameter (ONSD) using ocular ultrasonography has shown a promise in predicting increased intracranial pressure (ICP). However, this method is dependent on operator technique and equipment availability. We propose an alternative method of measuring ONSD and Marshall score grading by utilizing initial computed tomography (CT) head obtained on admission. We believe that such a technique could help predict patients requiring an invasive ICP monitor on admission. Methods: Patients were retrospectively selected from the neurosurgery database of a level II trauma center. Control patients originated from a database of nontraumatic brain injury (TBI) patients with a negative CT head and no intracranial pathology. Study subjects included patients aged 18–90 years, who sustained a severe TBI requiring placement of an ICP monitor on admission. All patients had a non-contrast CT head before the placement of an ICP monitor. Patients receiving any inte...
Original Article, 2022
Objective: The purpose of this study was to quantitatively evaluate if the use of the optic nerve sheath diameter (ONSD) can be a suitable noninvasive surrogate approach for repeated invasive intracranial pressure (ICP) measures. Methods: The study used a sample of 22 adult patients with traumatic brain injury (TBI) from an in intensive care unit (ICU). ICP levels were measured using the gold standard and recorded in cmH20. ONSD was measured using ultrasonography with 5.6-5.7 MHz linear probe and recorded in millimeters. The data analysis was done using STATA software version 15. Results: The results showed a strong positive correlation between ICP and ONSD (r = 0.743, p = 0.001). The accuracy of the sonographic ONSD declined over time, starting from a high of 90.9% at the baseline and declining to a low of merely 20.0% after 48 hours. Conclusion: These findings indicate that the ONSD approach could be very useful alternative and noninvasive method for monitoring ICP.
New Optic Nerve Sonography Quality Criteria in the Diagnostic Evaluation of Traumatic Brain Injury
Critical care research and practice, 2018
New sonographic quality criteria to optimize optic nerve sheath diameter (ONSD) measurements were suggested. The latter were correlated to elevated intracranial pressure (ICP) in traumatic brain injury (TBI). We investigated whether ONSD measurements were correlated to simultaneous ICP measurements in severe TBI. Forty patients with severe TBI (Marshall Scale ≥II and GCS ≤8) participated in the study. All patients had an intraparenchymal ICP catheter inserted, while ONSD was measured bilaterally, upon admission and over the next 48 hours, based on the new sonographic criteria. A total of 400 ONSD measurements were performed, while mean ONSD values of both eyes were used in the analysis. ONSD measurements were strongly correlated to ICP values (=0.74, < 0.0001). Receiver operator curve (ROC) analysis revealed that the ONSD cutoff value for predicting elevated ICP was 6.4 mm when using the mean of both eyes (AUC = 0.88, 95% CI = 0.80 to 0.95; sensitivity = 85.3%, specificity = 82.6...
2020
SUMMARY Optic nerve sheath diameter (ONSD) enlargement is detectable in traumatic brain injury patients with raised intracranial pressure (ICP). The aim was to assess its value in neurological patients suspected to have increased ICP. Patient clinical imaging data and hospitalization outcome were analyzed. Patients were divided into groups according to brain pathology and level of consciousness with Glasgow Coma Score (GCS). Poor hospitalization outcome was assessed by modified Rankin scale (mRS) >3. Data obtained by ocular sonography performed in acute setting were compared with data of 100 control subjects. Data were expressed as mean ± SD. Intergroup comparison was performed by Student’s t-test. Data of 34 patients (63+16 years) were suitable for analysis, including 8 primary intracerebral hemorrhage (PICH), 8 subarachnoid hemorrhage (SAH), 12 PICH or SAH and intraventricular hemorrhage (IVH), 4 tumors and 2 ischemic strokes. The mean ONSD was 5.86+0.69 mm in patients versus 4...
SBMU publishig, 2013
Introduction: Timely diagnosis and treatment of post-traumatic elevated intracranial pressure (EICP) could be re-duced morbidity and mortality, and improved patients’ outcome. This study is trying to evaluate the diagnostic accu-racy of sonographic optic nerve sheath diameter (ONSD) in detection of EICP. Methods: Sonographic ONSD of pa-tients with head trauma or cerebrovascular accident suspicious for EICP were evaluated by a trained chief resident of emergency medicine, who was blind to the clinical and brain computed tomography scan (BCT) findings of patients. Immediately after ultrasonography, BCT was performed and reported by an expert radiologist without awareness from other results of the patients. Finally, ultrasonographic and BCT findings regarding EICP were compared. To evaluate the ability of sonographic ONSD in predicting the BCT findings and obtain best cut-off level, receiver operat-ing characteristic (ROC) curve were used. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of sonographic ONSD in determin-ing of EICP was calculated. P < 0.05 was considered as statistically significant. Results: There were 222 patients (65.3% male), with mean age of 42.2±19.5 years (range: 16-90 years). BCT showed signs of EICP, in 28 cases (12.6%). The means of the ONSD in the patients with EICP and normal ICP were 5.5 ± 0.56 and 3.93 ± 0.53 mm, re-spectively (P<0.0001). ROC curve demonstrated that the best cut off was 4.85 mm. Sensitivity, specificity, PPV, NPV, PLR, and NLR of ONSD for prediction of EICP were 96.4%, 95.3%, 72.2%, 98.9%, 20.6, and 0.04, respectively. Con-clusion: Sonographic diameter of optic nerve sheath could be considered as an available, accurate, and noninvasive screening tool in determining the elevated intracranial pressure in cases with head trauma or cerebrovascular acci-dent.
Neurocritical care, 2014
Increased intracranial pressure (ICP) is associated with worse outcomes following traumatic brain injury (TBI). Studies have confirmed that ICP is correlated with optic nerve sheath diameter (ONSD) on ultrasound. The aim of our study was to assess the independent relationship between ONSD measured using CT and mortality in a population of patients admitted with severe TBI. We conducted a retrospective cohort study of patients with a TBI requiring ICP monitoring admitted to the ICU between April 2006 and May 2012 to two neurotrauma centers. ONSD was independently measured by two physicians blinded to patient outcomes. Multivariable logistic regression modeling was used to assess an association between ONSD and hospital mortality. A total of 220 patients were included in the analysis. Overall, the cohort had a mean age of 35 (SD 17) years and 171 of 220 (79 %) were male. The median admission GCS was 6 (IQR 3-8). Intra-class correlation coefficient between raters for ONSD measurements ...
Journal of the Neurological Sciences, 2016
Our objective was to apply the technique of measuring diameters of optic nerve sheath (ONSD) for the intracranial pressure assessment for the cases with traumatic head injury without hemorrhage. In a retrospective study, CT data of 720 adult patients were collected and analyzed. ONSDs were measured at the point where the ophthalmic artery crosses the optic nerve (anatomical landmark) together with the eyeball transverse diameter (ETD). The ONSD/ETD index was calculated. The correlation analysis was performed with gender, age, the Glasgow Coma Scale score, and the Glasgow Outcome Score. ONSD was enlarged in 82% cases (n = 591). Enlarged right/left ONSDs were 6.7 ± 1.0/6.7 ± 0.9 mm (cut-off value ˃ 5.5 mm). ONSD/ETD ratio was 0.28 ± 0.05 against 0.19 ± 0.02 in healthy adults (p = 0.02). We did not find correlation between ONSD/ETD ratio with initial Glasgow Coma Scale score but there was an inverse correlation between ONSD/ETD ratio and the Glasgow Outcome Score (r = −0.64). We conclude that in majority of cases with traumatic head injury without hemorrhage the ONSD is significantly enlarged indicating elevated intracranial pressure even if CT scans are negative.
Optic nerve sheath measurement and raised intracranial pressure in paediatric traumatic brain injury
European Journal of Trauma and Emergency Surgery, 2011
Introduction The optimal management of children ventilated for more than 4 h with traumatic brain injury (TBI) necessitates invasive intracranial pressure (ICP) monitoring, though some patients never have raised ICP. If noninvasive screening can reliably rule out elevated ICP, invasive devices can be limited to those in whom neurointensive care measures are indicated. Materials and methods We measured the optic nerve sheath diameter (ONSD) with a 10-MHz ultrasound probe in 11 children (age range 2-15 years, median 9.2 years) with severe TBI admitted to a regional neuro-surgical paediatric intensive care unit (PICU) requiring ICP monitoring and neuro-protection. Simultaneous invasive ICP was recorded and more than 15 mmHg was considered to be abnormal. ONSD [4.5 mm in children over 1 year of age was considered to be abnormal. Results and conclusions All children with clinically significantly raised ICP had abnormal ONSD, whereas those with normal ICP did not. Despite the small numbers, this study suggests that the ONSD may be useful in identifying children with TBI and normal ICP and, so, help avoid the insertion of unnecessary ICP monitors.
Frontiers in Pediatrics
Background and AimsIntracranial Hypertension (ICH) is a life-threatening complication of brain injury. The invasive measurement of intracranial pressure (ICP) remains the gold standard to diagnose ICH. Measurement of Optic Nerve Sheath Diameter (ONSD) using ultrasonography is a non-invasive method for detecting ICH. However, data on paediatric brain injury are scarce. The aim of the study was to determine the performance of the initial ONSD measurement to predict ICH occurring in children with severe brain injury and to describe the ONSD values in a control group.MethodsIn this cross-sectional study, ONSD was measured in children aged 2 months-17 years old with invasive ICP monitoring: before placement of ICP probe and within the 60 min after, and then daily during 3 days. ONSD was also measured in a control group.ResultsNinety-nine patients were included, of whom 97 were analysed, with a median (IQR) age of 8.7 [2.3–13.6] years. The median (IQR) PIM 2 score was 6.6 [4.4–9.7] and th...