Abstract
Introduction
Bedside ultrasound measurement of optic nerve sheath diameter (ONSD) is emerging as
a non-invasive technique to evaluate and predict raised intracranial pressure (ICP).
It has been shown in previous literature that ONSD measurement has good correlation
with surrogate findings of raised ICP such as clinical and radiological findings suggestive
of raised ICP.
Objectives
The objective of the study is to find a correlation between sonographic measurements
of ONSD value with ICP value measured via the gold standard invasive intracranial
ICP catheter, and to find the cut-off value of ONSD measurement in predicting raised
ICP, along with its sensitivity and specificity value.
Methods
A prospective observational study was performed using convenience sample of 41 adult
neurosurgical patients treated in neurosurgical intensive care unit with invasive
intracranial pressure monitoring placed in-situ as part of their clinical care. Portable
SonoSite ultrasound machine with 7 MHz linear probe were used to measure optic nerve
sheath diameter using the standard technique. Simultaneous ICP readings were obtained
directly from the invasive monitoring.
Results
Seventy-five measurements were performed on 41 patients. The non-parametric Spearman
correlation test revealed a significant correlation at the 0.01 level between the
ICP and ONSD value, with correlation coefficient of 0.820. The receiver operating
characteristic curve generated an area under the curve with the value of 0.964, and
with standard error of 0.22. From the receiver operating characteristic curve, we
found that the ONSD value of 5.205 mm is 95.8% sensitive and 80.4% specific in detecting
raised ICP.
Conclusions
ONSD value of 5.205 is sensitive and specific in detecting raised ICP. Bedside ultrasound
measurement of ONSD is readily learned, and is reproducible and reliable in predicting
raised ICP. This non-invasive technique can be a useful adjunct to the current invasive
intracranial catheter monitoring, and has wide potential clinical applications in
district hospitals, emergency departments and intensive care units.
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D; use, select 'Corporate R&D; Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diagnostic criteria for idiopathic intracranial hypertension.Neurology. 2002; 59: 1492-1495
- Guidelines for the management of severe head injury. Brain trauma foundation.Eur J Emerg Med. 1996; 3: 109-127
- Monitoring and interpretation of intracranial pressure after head injury.Acta Neurochir Suppl. 2006; 96: 114-118
- Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure.Acad Emerg Med. 2008; 15: 201-204
- Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath.Acad Emerg Med. 2003; 10: 376-381
- Sonographic optic nerve sheath diameter as an estimate of intracranial pressure in adult trauma.J Surg Res. 2011; 170: 265-271
- Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients.Intensive Care Med. 2008; 34: 2062-2067
- Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus.Br J Ophthalmol. 2002; 86: 1109-1113
- Measurement and relationship of subarachnoid pressure of the optic nerve to intra- cranial pressures in fresh cadavers.Am J Ophthalmol. 1993; 116: 548-556
- Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults, European J of.Ultrasound. 2012; 5: 145-149
- Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients.Ann Emerg Med. 2007; 49: 508-514
- Optic nerve sonography: a new window for the non-invasive evaluation of intracranial pressure in brain injury.Emerg Med J. 2009; 26: 630-634
- Intracranial pressure is still number 1 despite BEST:TRIP study.World Neurosurg. 2013; 79: 599-600
- Intracranial pressure monitoring in severe traumatic brain injury.World Neurosurg. 2013; 79: 600-601
- Intracranial pressure monitoring in severe traumatic brain injury: who is still bold enough to keep sinning against the level 1 evidence.World Neurosurg. 2013; 79: 602-604
Article Info
Publication History
Published online: September 23, 2016
Accepted:
September 20,
2016
Received in revised form:
September 18,
2016
Received:
July 27,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
