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Sonographic optic nerve sheath diameter as an estimate of intracranial pressure in adult trauma.
J Surg Res 2011; 170(2):265-71JS

Abstract

BACKGROUND

Intracranial pressure (ICP) is currently measured with invasive monitoring. Sonographic optic nerve sheath diameter (ONSD) may provide a noninvasive estimate of ICP. Our hypothesis was that bedside ONSD accurately estimates ICP in acutely injured patients. The specific aims were (1) to determine the accuracy of ONSD in estimating elevated ICP, (2) to correlate ONSD and ICP in unilateral and bilateral head injuries, and (3) to determine the effect of ICP monitor placement on ONSD measurements.

MATERIALS AND METHODS

A blinded prospective study of adult trauma patients requiring ICP monitoring was performed at a University-based urban trauma center. The ONSD was measured by ultrasound pre- and post-placement of an ICP monitor (Camino Bolt or Ventriculostomy).

RESULTS

One-hundred fourteen measurements were obtained in 10 trauma patients requiring ICP monitoring. Pre- and post-ONSD were compared with side of injury in the presence of an ICP monitor. ROC analysis demonstrated ONSD poorly estimates elevated ICP (AUC = 0.36). Overall sensitivity, specificity, PPV, NPV, and accuracy for estimating ICP with ONSD were 36%, 38%, 40%, 16%, and 37%. Poor correlation of ONSD to ICP was observed with unilateral (R(2) = 0.45, P < 0.01) and bilateral (R(2) = 0.21, P = 0.01) injuries. ICP monitor placement did not affect ONSD measurements on the right (P = 0.5), left (P = 0.4), or right and left sides combined (P = 0.3).

CONCLUSIONS

Sonographic ONSD as a surrogate for elevated ICP in lieu of invasive monitoring is not reliable due to poor accuracy and correlation.

Authors+Show Affiliations

Department of Surgery, University of California, San Francisco-East Bay, Oakland, California, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Validation Studies

Language

eng

PubMed ID

21550065

Citation

Strumwasser, Aaron, et al. "Sonographic Optic Nerve Sheath Diameter as an Estimate of Intracranial Pressure in Adult Trauma." The Journal of Surgical Research, vol. 170, no. 2, 2011, pp. 265-71.
Strumwasser A, Kwan RO, Yeung L, et al. Sonographic optic nerve sheath diameter as an estimate of intracranial pressure in adult trauma. J Surg Res. 2011;170(2):265-71.
Strumwasser, A., Kwan, R. O., Yeung, L., Miraflor, E., Ereso, A., Castro-Moure, F., ... Victorino, G. P. (2011). Sonographic optic nerve sheath diameter as an estimate of intracranial pressure in adult trauma. The Journal of Surgical Research, 170(2), pp. 265-71. doi:10.1016/j.jss.2011.03.009.
Strumwasser A, et al. Sonographic Optic Nerve Sheath Diameter as an Estimate of Intracranial Pressure in Adult Trauma. J Surg Res. 2011;170(2):265-71. PubMed PMID: 21550065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sonographic optic nerve sheath diameter as an estimate of intracranial pressure in adult trauma. AU - Strumwasser,Aaron, AU - Kwan,Rita O, AU - Yeung,Louise, AU - Miraflor,Emily, AU - Ereso,Alex, AU - Castro-Moure,Frederico, AU - Patel,Atul, AU - Sadjadi,Javid, AU - Victorino,Gregory P, Y1 - 2011/04/01/ PY - 2011/01/11/received PY - 2011/02/16/revised PY - 2011/03/03/accepted PY - 2011/5/10/entrez PY - 2011/5/10/pubmed PY - 2011/11/16/medline SP - 265 EP - 71 JF - The Journal of surgical research JO - J. Surg. Res. VL - 170 IS - 2 N2 - BACKGROUND: Intracranial pressure (ICP) is currently measured with invasive monitoring. Sonographic optic nerve sheath diameter (ONSD) may provide a noninvasive estimate of ICP. Our hypothesis was that bedside ONSD accurately estimates ICP in acutely injured patients. The specific aims were (1) to determine the accuracy of ONSD in estimating elevated ICP, (2) to correlate ONSD and ICP in unilateral and bilateral head injuries, and (3) to determine the effect of ICP monitor placement on ONSD measurements. MATERIALS AND METHODS: A blinded prospective study of adult trauma patients requiring ICP monitoring was performed at a University-based urban trauma center. The ONSD was measured by ultrasound pre- and post-placement of an ICP monitor (Camino Bolt or Ventriculostomy). RESULTS: One-hundred fourteen measurements were obtained in 10 trauma patients requiring ICP monitoring. Pre- and post-ONSD were compared with side of injury in the presence of an ICP monitor. ROC analysis demonstrated ONSD poorly estimates elevated ICP (AUC = 0.36). Overall sensitivity, specificity, PPV, NPV, and accuracy for estimating ICP with ONSD were 36%, 38%, 40%, 16%, and 37%. Poor correlation of ONSD to ICP was observed with unilateral (R(2) = 0.45, P < 0.01) and bilateral (R(2) = 0.21, P = 0.01) injuries. ICP monitor placement did not affect ONSD measurements on the right (P = 0.5), left (P = 0.4), or right and left sides combined (P = 0.3). CONCLUSIONS: Sonographic ONSD as a surrogate for elevated ICP in lieu of invasive monitoring is not reliable due to poor accuracy and correlation. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/21550065/Sonographic_optic_nerve_sheath_diameter_as_an_estimate_of_intracranial_pressure_in_adult_trauma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(11)00204-6 DB - PRIME DP - Unbound Medicine ER -