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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 Apr; 49(4):508-14.AE

Abstract

STUDY OBJECTIVE

Our objective is to determine whether a bedside ultrasonographic measurement of optic nerve sheath diameter can accurately predict the computed tomographic (CT) findings of elevated intracranial pressure in adult head injury patients in the emergency department (ED).

METHODS

We conducted a prospective, blinded observational study on adult ED patients with suspected intracranial injury with possible elevated intracranial pressure. Exclusion criteria were age younger than 18 years or obvious ocular trauma. Using a 7.5-MHz ultrasonographic probe on the closed eyelids, a single optic nerve sheath diameter was measured 3 mm behind the globe in each eye. A mean binocular optic nerve sheath diameter greater than 5.00 mm was considered abnormal. Cranial CT findings of shift, edema, or effacement suggestive of elevated intracranial pressure were used to evaluate optic nerve sheath diameter accuracy.

RESULTS

Fifty-nine patients were enrolled in the study. Average age was 38 years, and median Glasgow Coma Scale score was 15 (interquartile 6 to 15). Eight patients with an optic nerve sheath diameter of 5.00 mm or more had CT findings that correlated with elevated intracranial pressure. The sensitivity for the ultrasonography in detecting elevated intracranial pressure was 100% (95% confidence interval [CI] 68% to 100%) and specificity was 63% (95% CI 50% to 76%). The sensitivity of ultrasonography for detection of any traumatic intracranial injury found by CT was 84% (95% CI 60% to 97%) and specificity was 73% (95% CI 59% to 86%).

CONCLUSION

Bedside ED optic nerve sheath diameter ultrasonography has potential as a sensitive screening test for elevated intracranial pressure in adult head injury.

Authors+Show Affiliations

Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA. vtayal@carolinas.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16997419

Citation

Tayal, Vivek S., et al. "Emergency Department Sonographic Measurement of Optic Nerve Sheath Diameter to Detect Findings of Increased Intracranial Pressure in Adult Head Injury Patients." Annals of Emergency Medicine, vol. 49, no. 4, 2007, pp. 508-14.
Tayal VS, Neulander M, Norton HJ, et al. 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(4):508-14.
Tayal, V. S., Neulander, M., Norton, H. J., Foster, T., Saunders, T., & Blaivas, M. (2007). Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Annals of Emergency Medicine, 49(4), 508-14.
Tayal VS, et al. 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(4):508-14. PubMed PMID: 16997419.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. AU - Tayal,Vivek S, AU - Neulander,Matthew, AU - Norton,H James, AU - Foster,Troy, AU - Saunders,Timothy, AU - Blaivas,Michael, Y1 - 2006/09/25/ PY - 2006/05/03/received PY - 2006/06/09/revised PY - 2006/06/13/accepted PY - 2006/9/26/pubmed PY - 2007/4/12/medline PY - 2006/9/26/entrez SP - 508 EP - 14 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 49 IS - 4 N2 - STUDY OBJECTIVE: Our objective is to determine whether a bedside ultrasonographic measurement of optic nerve sheath diameter can accurately predict the computed tomographic (CT) findings of elevated intracranial pressure in adult head injury patients in the emergency department (ED). METHODS: We conducted a prospective, blinded observational study on adult ED patients with suspected intracranial injury with possible elevated intracranial pressure. Exclusion criteria were age younger than 18 years or obvious ocular trauma. Using a 7.5-MHz ultrasonographic probe on the closed eyelids, a single optic nerve sheath diameter was measured 3 mm behind the globe in each eye. A mean binocular optic nerve sheath diameter greater than 5.00 mm was considered abnormal. Cranial CT findings of shift, edema, or effacement suggestive of elevated intracranial pressure were used to evaluate optic nerve sheath diameter accuracy. RESULTS: Fifty-nine patients were enrolled in the study. Average age was 38 years, and median Glasgow Coma Scale score was 15 (interquartile 6 to 15). Eight patients with an optic nerve sheath diameter of 5.00 mm or more had CT findings that correlated with elevated intracranial pressure. The sensitivity for the ultrasonography in detecting elevated intracranial pressure was 100% (95% confidence interval [CI] 68% to 100%) and specificity was 63% (95% CI 50% to 76%). The sensitivity of ultrasonography for detection of any traumatic intracranial injury found by CT was 84% (95% CI 60% to 97%) and specificity was 73% (95% CI 59% to 86%). CONCLUSION: Bedside ED optic nerve sheath diameter ultrasonography has potential as a sensitive screening test for elevated intracranial pressure in adult head injury. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/16997419/Emergency_department_sonographic_measurement_of_optic_nerve_sheath_diameter_to_detect_findings_of_increased_intracranial_pressure_in_adult_head_injury_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(06)00943-7 DB - PRIME DP - Unbound Medicine ER -