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Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury.
Intensive Care Med 2014; 40(9):1267-74IC

Abstract

PURPOSE

Assess the relationship between optic nerve sheath diameter (ONSD) measured on bedside portable computed tomography (CT) scans and simultaneously measured intracranial pressure (ICP) in patients with severe traumatic brain injury.

METHODS

Retrospective cohort study of 57 patients admitted between 2009 and 2013. Linear and logistic regression were used to model the correlation and discrimination between ONSD and ICP or intracranial hypertension, respectively.

RESULTS

The cohort had a mean age of 40 years (SD 16) and a median admission Glasgow coma score of 7 (IQR 4-10). The between-rater agreement by intraclass coefficient was 0.89 (95 % CI 0.83-0.93, P < 0.001). The mean ONSD was 6.7 mm (SD 0.75) and the mean ICP during CT was 21.3 mmHg (SD 8.4). Using linear regression, there was a strong correlation between ICP and ONSD (r = 0.74, P < 0.001). ONSD had an area under the curve to discriminate elevated ICP (≥20 mmHg vs. <20 mmHg) of 0.83 (95 % CI 0.73-0.94). Using a cutoff of 6.0 mm, ONSD had a sensitivity of 97 %, specificity of 42 %, positive predictive value of 67 %, and a negative predictive value of 92 %. Comparing linear regression models, ONSD was a much stronger predictor of ICP (R(2) of 0.56) compared to other CT features (R(2) of 0.21).

CONCLUSIONS

Simultaneous measurement of ONSD on CT and ICP were strongly correlated and ONSD was discriminative for intracranial hypertension. ONSD was much more predictive of ICP than other CT features. There was excellent agreement between raters in measuring ONSD.

Authors+Show Affiliations

Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada, mypindersekhon@gmail.com.No affiliation info availableNo affiliation info availableNo 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)

Journal Article

Language

eng

PubMed ID

25034476

Citation

Sekhon, Mypinder S., et al. "Optic Nerve Sheath Diameter On Computed Tomography Is Correlated With Simultaneously Measured Intracranial Pressure in Patients With Severe Traumatic Brain Injury." Intensive Care Medicine, vol. 40, no. 9, 2014, pp. 1267-74.
Sekhon MS, Griesdale DE, Robba C, et al. Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury. Intensive Care Med. 2014;40(9):1267-74.
Sekhon, M. S., Griesdale, D. E., Robba, C., McGlashan, N., Needham, E., Walland, K., ... Menon, D. K. (2014). Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury. Intensive Care Medicine, 40(9), pp. 1267-74. doi:10.1007/s00134-014-3392-7.
Sekhon MS, et al. Optic Nerve Sheath Diameter On Computed Tomography Is Correlated With Simultaneously Measured Intracranial Pressure in Patients With Severe Traumatic Brain Injury. Intensive Care Med. 2014;40(9):1267-74. PubMed PMID: 25034476.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury. AU - Sekhon,Mypinder S, AU - Griesdale,Donald E, AU - Robba,Chiara, AU - McGlashan,Nick, AU - Needham,Edward, AU - Walland,Katherine, AU - Shook,Alyssa C, AU - Smielewski,Peter, AU - Czosnyka,Marek, AU - Gupta,Arun K, AU - Menon,David K, Y1 - 2014/07/18/ PY - 2014/05/28/received PY - 2014/07/01/accepted PY - 2014/7/19/entrez PY - 2014/7/19/pubmed PY - 2015/5/15/medline SP - 1267 EP - 74 JF - Intensive care medicine JO - Intensive Care Med VL - 40 IS - 9 N2 - PURPOSE: Assess the relationship between optic nerve sheath diameter (ONSD) measured on bedside portable computed tomography (CT) scans and simultaneously measured intracranial pressure (ICP) in patients with severe traumatic brain injury. METHODS: Retrospective cohort study of 57 patients admitted between 2009 and 2013. Linear and logistic regression were used to model the correlation and discrimination between ONSD and ICP or intracranial hypertension, respectively. RESULTS: The cohort had a mean age of 40 years (SD 16) and a median admission Glasgow coma score of 7 (IQR 4-10). The between-rater agreement by intraclass coefficient was 0.89 (95 % CI 0.83-0.93, P < 0.001). The mean ONSD was 6.7 mm (SD 0.75) and the mean ICP during CT was 21.3 mmHg (SD 8.4). Using linear regression, there was a strong correlation between ICP and ONSD (r = 0.74, P < 0.001). ONSD had an area under the curve to discriminate elevated ICP (≥20 mmHg vs. <20 mmHg) of 0.83 (95 % CI 0.73-0.94). Using a cutoff of 6.0 mm, ONSD had a sensitivity of 97 %, specificity of 42 %, positive predictive value of 67 %, and a negative predictive value of 92 %. Comparing linear regression models, ONSD was a much stronger predictor of ICP (R(2) of 0.56) compared to other CT features (R(2) of 0.21). CONCLUSIONS: Simultaneous measurement of ONSD on CT and ICP were strongly correlated and ONSD was discriminative for intracranial hypertension. ONSD was much more predictive of ICP than other CT features. There was excellent agreement between raters in measuring ONSD. SN - 1432-1238 UR - https://www.unboundmedicine.com/medline/citation/25034476/Optic_nerve_sheath_diameter_on_computed_tomography_is_correlated_with_simultaneously_measured_intracranial_pressure_in_patients_with_severe_traumatic_brain_injury_ L2 - https://dx.doi.org/10.1007/s00134-014-3392-7 DB - PRIME DP - Unbound Medicine ER -