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Optic nerve sheath diameter measurement: a means of detecting raised ICP in adult traumatic and non-traumatic neurosurgical patients.
Am J Emerg Med 2017; 35(1):150-153AJ

Abstract

INTRODUCTION

Bedside ultrasound measurement of optic nerve sheath diameter (ONSD) is emerging as a non-invasive technique to evaluate and predict raised intracranial pressure (ICP). It has been shown in previous literature that ONSD measurement has good correlation with surrogate findings of raised ICP such as clinical and radiological findings suggestive of raised ICP.

OBJECTIVES

The objective of the study is to find a correlation between sonographic measurements of ONSD value with ICP value measured via the gold standard invasive intracranial ICP catheter, and to find the cut-off value of ONSD measurement in predicting raised ICP, along with its sensitivity and specificity value.

METHODS

A prospective observational study was performed using convenience sample of 41 adult neurosurgical patients treated in neurosurgical intensive care unit with invasive intracranial pressure monitoring placed in-situ as part of their clinical care. Portable SonoSite ultrasound machine with 7 MHz linear probe were used to measure optic nerve sheath diameter using the standard technique. Simultaneous ICP readings were obtained directly from the invasive monitoring.

RESULTS

Seventy-five measurements were performed on 41 patients. The non-parametric Spearman correlation test revealed a significant correlation at the 0.01 level between the ICP and ONSD value, with correlation coefficient of 0.820. The receiver operating characteristic curve generated an area under the curve with the value of 0.964, and with standard error of 0.22. From the receiver operating characteristic curve, we found that the ONSD value of 5.205 mm is 95.8% sensitive and 80.4% specific in detecting raised ICP.

CONCLUSIONS

ONSD value of 5.205 is sensitive and specific in detecting raised ICP. Bedside ultrasound measurement of ONSD is readily learned, and is reproducible and reliable in predicting raised ICP. This non-invasive technique can be a useful adjunct to the current invasive intracranial catheter monitoring, and has wide potential clinical applications in district hospitals, emergency departments and intensive care units.

Authors+Show Affiliations

Kuala Lumpur Hospital, Jalan Pahang, 50586, Kuala Lumpur, Malaysia. Electronic address: raffiz_dr@yahoo.co.uk.Centre for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, Kota Bharu, Kelantan, Malaysia; Department of Neurosciences, Hospital Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

27852525

Citation

Raffiz, Mohd, and Jafri M. Abdullah. "Optic Nerve Sheath Diameter Measurement: a Means of Detecting Raised ICP in Adult Traumatic and Non-traumatic Neurosurgical Patients." The American Journal of Emergency Medicine, vol. 35, no. 1, 2017, pp. 150-153.
Raffiz M, Abdullah JM. Optic nerve sheath diameter measurement: a means of detecting raised ICP in adult traumatic and non-traumatic neurosurgical patients. Am J Emerg Med. 2017;35(1):150-153.
Raffiz, M., & Abdullah, J. M. (2017). Optic nerve sheath diameter measurement: a means of detecting raised ICP in adult traumatic and non-traumatic neurosurgical patients. The American Journal of Emergency Medicine, 35(1), pp. 150-153. doi:10.1016/j.ajem.2016.09.044.
Raffiz M, Abdullah JM. Optic Nerve Sheath Diameter Measurement: a Means of Detecting Raised ICP in Adult Traumatic and Non-traumatic Neurosurgical Patients. Am J Emerg Med. 2017;35(1):150-153. PubMed PMID: 27852525.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optic nerve sheath diameter measurement: a means of detecting raised ICP in adult traumatic and non-traumatic neurosurgical patients. AU - Raffiz,Mohd, AU - Abdullah,Jafri M, Y1 - 2016/09/23/ PY - 2016/07/27/received PY - 2016/09/18/revised PY - 2016/09/20/accepted PY - 2016/11/18/pubmed PY - 2017/3/21/medline PY - 2016/11/18/entrez SP - 150 EP - 153 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 35 IS - 1 N2 - INTRODUCTION: Bedside ultrasound measurement of optic nerve sheath diameter (ONSD) is emerging as a non-invasive technique to evaluate and predict raised intracranial pressure (ICP). It has been shown in previous literature that ONSD measurement has good correlation with surrogate findings of raised ICP such as clinical and radiological findings suggestive of raised ICP. OBJECTIVES: The objective of the study is to find a correlation between sonographic measurements of ONSD value with ICP value measured via the gold standard invasive intracranial ICP catheter, and to find the cut-off value of ONSD measurement in predicting raised ICP, along with its sensitivity and specificity value. METHODS: A prospective observational study was performed using convenience sample of 41 adult neurosurgical patients treated in neurosurgical intensive care unit with invasive intracranial pressure monitoring placed in-situ as part of their clinical care. Portable SonoSite ultrasound machine with 7 MHz linear probe were used to measure optic nerve sheath diameter using the standard technique. Simultaneous ICP readings were obtained directly from the invasive monitoring. RESULTS: Seventy-five measurements were performed on 41 patients. The non-parametric Spearman correlation test revealed a significant correlation at the 0.01 level between the ICP and ONSD value, with correlation coefficient of 0.820. The receiver operating characteristic curve generated an area under the curve with the value of 0.964, and with standard error of 0.22. From the receiver operating characteristic curve, we found that the ONSD value of 5.205 mm is 95.8% sensitive and 80.4% specific in detecting raised ICP. CONCLUSIONS: ONSD value of 5.205 is sensitive and specific in detecting raised ICP. Bedside ultrasound measurement of ONSD is readily learned, and is reproducible and reliable in predicting raised ICP. This non-invasive technique can be a useful adjunct to the current invasive intracranial catheter monitoring, and has wide potential clinical applications in district hospitals, emergency departments and intensive care units. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/27852525/Optic_nerve_sheath_diameter_measurement:_a_means_of_detecting_raised_ICP_in_adult_traumatic_and_non_traumatic_neurosurgical_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(16)30622-2 DB - PRIME DP - Unbound Medicine ER -