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Utility of optic nerve ultrasonography in head injury.
Injury. 2008 May; 39(5):519-24.I

Abstract

BACKGROUND

CT has evolved as the gold standard for evaluation of head injury, but early CT is not always possible. Bedside ultrasonography is available in most trauma units and optic nerve ultrasound (ONUS) examination should be feasible.

OBJECTIVE

To evaluate the role of ONUS for people with head injury.

SETTING

Tertiary care trauma service in a teaching hospital in a large metropolitan city in India.

DESIGN

Prospective, blinded, observational study.

METHODS

From April 2006 to January 2007, all adult patients with head injury but without obvious ocular trauma, for whom it was possible to perform CT, were enrolled. Using a 7.5-MHz ultrasonographic probe on the closed eyelids, optic nerve sheath diameter (ONSD) was measured on either side. A mean binocular ONSD less than 5.00 mm was considered normal. Cranial CT findings were used as a reference standard to evaluate ONUS.

RESULTS

The study included 100 participants (72 men, 28 women, median age 28 years, median Glasgow Coma Scale score 11). Clinical features did not correlate with CT for signs of raised intracranial pressure (ICP). The mean binocular ONSD (5.8+/-0.57 mm) was significantly increased among individuals with signs of raised ICP on CT compared with the mean ONSD (3.5+/-0.75 mm) among those without such signs. ONUS revealed evidence of raised ICP in 74 cases (confirmed by CT in 72 cases), 59 of whom had significant intracranial haematoma needing surgical evacuation. Of the 26 cases with negative ONUS, confirmed by CT in 25 cases, only 1 needed surgical intervention for drainage of intracranial haematoma. ONUS was false positive for two and false negative for one person. The sensitivity of ONUS in detecting elevated ICP was 98.6%, specificity 92.8%, positive predictive value 97.26% and negative predictive value 96.3%.

CONCLUSION

ONUS has potential as a sensitive bedside screening test for detecting raised ICP and the presence of intracranial haematoma needing surgical intervention in adult head injury. This can be of immense help for unstable patients, in mass casualty situations and in remote locations.

Authors+Show Affiliations

Trauma Service, Department of Surgery, L.T.M. Medical College and L.T.M.G. Hospital, Sion, Mumbai, India. docravishankar@yahoo.co.inNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

18325519

Citation

Goel, Ravishankar S., et al. "Utility of Optic Nerve Ultrasonography in Head Injury." Injury, vol. 39, no. 5, 2008, pp. 519-24.
Goel RS, Goyal NK, Dharap SB, et al. Utility of optic nerve ultrasonography in head injury. Injury. 2008;39(5):519-24.
Goel, R. S., Goyal, N. K., Dharap, S. B., Kumar, M., & Gore, M. A. (2008). Utility of optic nerve ultrasonography in head injury. Injury, 39(5), 519-24. https://doi.org/10.1016/j.injury.2007.09.029
Goel RS, et al. Utility of Optic Nerve Ultrasonography in Head Injury. Injury. 2008;39(5):519-24. PubMed PMID: 18325519.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utility of optic nerve ultrasonography in head injury. AU - Goel,Ravishankar S, AU - Goyal,Navin K, AU - Dharap,Satish B, AU - Kumar,Meena, AU - Gore,Madhuri A, Y1 - 2008/03/05/ PY - 2007/06/17/received PY - 2007/08/20/revised PY - 2007/09/24/accepted PY - 2008/3/8/pubmed PY - 2008/11/14/medline PY - 2008/3/8/entrez SP - 519 EP - 24 JF - Injury JO - Injury VL - 39 IS - 5 N2 - BACKGROUND: CT has evolved as the gold standard for evaluation of head injury, but early CT is not always possible. Bedside ultrasonography is available in most trauma units and optic nerve ultrasound (ONUS) examination should be feasible. OBJECTIVE: To evaluate the role of ONUS for people with head injury. SETTING: Tertiary care trauma service in a teaching hospital in a large metropolitan city in India. DESIGN: Prospective, blinded, observational study. METHODS: From April 2006 to January 2007, all adult patients with head injury but without obvious ocular trauma, for whom it was possible to perform CT, were enrolled. Using a 7.5-MHz ultrasonographic probe on the closed eyelids, optic nerve sheath diameter (ONSD) was measured on either side. A mean binocular ONSD less than 5.00 mm was considered normal. Cranial CT findings were used as a reference standard to evaluate ONUS. RESULTS: The study included 100 participants (72 men, 28 women, median age 28 years, median Glasgow Coma Scale score 11). Clinical features did not correlate with CT for signs of raised intracranial pressure (ICP). The mean binocular ONSD (5.8+/-0.57 mm) was significantly increased among individuals with signs of raised ICP on CT compared with the mean ONSD (3.5+/-0.75 mm) among those without such signs. ONUS revealed evidence of raised ICP in 74 cases (confirmed by CT in 72 cases), 59 of whom had significant intracranial haematoma needing surgical evacuation. Of the 26 cases with negative ONUS, confirmed by CT in 25 cases, only 1 needed surgical intervention for drainage of intracranial haematoma. ONUS was false positive for two and false negative for one person. The sensitivity of ONUS in detecting elevated ICP was 98.6%, specificity 92.8%, positive predictive value 97.26% and negative predictive value 96.3%. CONCLUSION: ONUS has potential as a sensitive bedside screening test for detecting raised ICP and the presence of intracranial haematoma needing surgical intervention in adult head injury. This can be of immense help for unstable patients, in mass casualty situations and in remote locations. SN - 0020-1383 UR - https://www.unboundmedicine.com/medline/citation/18325519/Utility_of_optic_nerve_ultrasonography_in_head_injury_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0020-1383(07)00410-X DB - PRIME DP - Unbound Medicine ER -