Acute Crit Care.  2024 Feb;39(1):155-161. 10.4266/acc.2023.01172.

Bedside ultrasonographic evaluation of optic nerve sheath diameter for monitoring of intracranial pressure in traumatic brain injury patients: a cross sectional study in level II trauma care center in India

• Kshirsagar SJ
• Pande AH
• Naik SV
• Yadav A
• Sakhala RM
• Salve SM
• Nuhaimah A
• Desai P

• KMID: 2555234
• DOI: http://doi.org/10.4266/acc.2023.01172

Abstract

Background
Optic nerve sheath diameter (ONSD) is an emerging non-invasive, easily accessible, and possibly useful measurement for evaluating changes in intracranial pressure (ICP). The utilization of bedside ultrasonography (USG) to measure ONSD has garnered increased attention due to its portability, real-time capability, and lack of ionizing radiation. The primary aim of the study was to assess whether bedside USG-guided ONSD measurement can reliably predict increased ICP in traumatic brain injury (TBI) patients. Methods: A total of 95 patients admitted to the trauma intensive care unit was included in this cross sectional study. Patient brain computed tomography (CT) scans and Glasgow Coma Scale (GCS) scores were assessed at the time of admission. Bedside USG-guided binocular ONSD was measured and the mean ONSD was noted. Microsoft Excel was used for statistical analysis. Results: Patients with low GCS had higher mean ONSD values (6.4±1.0 mm). A highly significant association was found among the GCS, CT results, and ONSD measurements (P<0.001). Compared to CT scans, the bedside USG ONSD had 86.42% sensitivity and 64.29% specificity for detecting elevated ICP. The positive predictive value of ONSD to identify elevated ICP was 93.33%, and its negative predictive value was 45.00%. ONSD measurement accuracy was 83.16%. Conclusions: Increased ICP can be accurately predicted by bedside USG measurement of ONSD and can be a valuable adjunctive tool in the management of TBI patients.

Keyword

intracranial pressure monitoring; optic nerve sheath diameter; traumatic brain injury

Figure

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  Figure 1. Flowchart of the study.

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  Figure 2. Receiver operating characteristic (ROC) curve analysis of optic nerve sheath diameter.

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