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Ultrasonographic optic nerve sheath diameter correlation with ICP and accuracy as a tool for noninvasive surrogate ICP measurement in patients with decompressive craniotomy.
J Neurosurg 2019; :1-7JN

Abstract

OBJECTIVE

Increased intracranial pressure (ICP) results in enlarged optic nerve sheath diameter (ONSD). In this study the authors aimed to assess the association of ONSD and ICP in severe traumatic brain injury (TBI) after decompressive craniotomy (DC).

METHODS

ONSDs were measured by ocular ultrasonography in 40 healthy control adults. ICPs were monitored invasively with a microsensor at 6 hours and 24 hours after DC operation in 35 TBI patients. ONSDs were measured at the same time in these patients. Patients were assigned to 3 groups according to ICP levels, including normal (ICP ≤ 13 mm Hg), mildly elevated (ICP = 14-22 mm Hg), and severely elevated (ICP > 22 mm Hg) groups. ONSDs were compared between healthy control adults and TBI cases with DC. Then, the association of ONSD with ICP was analyzed using Pearson's correlation coefficient, linear regression analysis, and receiver operator characteristic curves.

RESULTS

Seventy ICP measurements were obtained among 35 TBI patients after DC, including 25, 27, and 18 measurements in the normal, mildly elevated, and severely elevated ICP groups, respectively. Mean ONSDs were 4.09 ± 0.38 mm in the control group and 4.92 ± 0.37, 5.77 ± 0.41, and 6.52 ± 0.44 mm in the normal, mildly elevated, and severely elevated ICP groups, respectively (p < 0.001). A significant linear correlation was found between ONSD and ICP (r = 0.771, p < 0.0001). Enlarged ONSD was a robust predictor of elevated ICP. With an ONSD cutoff of 5.48 mm (ICP > 13 mm Hg), sensitivity and specificity were 91.1% and 88.0%, respectively; a cutoff of 5.83 mm (ICP > 22 mm Hg) yielded sensitivity and specificity of 94.4% and 81.0%, respectively.

CONCLUSIONS

Ultrasonographic ONSD is strongly correlated with invasive ICP measurements and may serve as a sensitive and noninvasive method for detecting elevated ICP in TBI patients after DC.

Authors+Show Affiliations

1Department of Intensive Care Unit, Xiamen Cardiovascular Hospital, Xiamen University. 2Department of Intensive Care Unit, Third Hospital of Xiamen Affiliated of Fujian University of Traditional Chinese Medicine.3Department of Intensive Care Unit, Xiang'an Hospital of Xiamen University.4Department of Neurosurgery, Third Hospital of Xiamen Affiliated of Fujian University of Traditional Chinese Medicine; and.2Department of Intensive Care Unit, Third Hospital of Xiamen Affiliated of Fujian University of Traditional Chinese Medicine.2Department of Intensive Care Unit, Third Hospital of Xiamen Affiliated of Fujian University of Traditional Chinese Medicine.2Department of Intensive Care Unit, Third Hospital of Xiamen Affiliated of Fujian University of Traditional Chinese Medicine.5Department of Healthcare, Xiamen Port Clinic of Xiamen Customs, Xiamen, Fujian, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31323632

Citation

Wang, Juxiang, et al. "Ultrasonographic Optic Nerve Sheath Diameter Correlation With ICP and Accuracy as a Tool for Noninvasive Surrogate ICP Measurement in Patients With Decompressive Craniotomy." Journal of Neurosurgery, 2019, pp. 1-7.
Wang J, Li K, Li H, et al. Ultrasonographic optic nerve sheath diameter correlation with ICP and accuracy as a tool for noninvasive surrogate ICP measurement in patients with decompressive craniotomy. J Neurosurg. 2019.
Wang, J., Li, K., Li, H., Ji, C., Wu, Z., Chen, H., & Chen, B. (2019). Ultrasonographic optic nerve sheath diameter correlation with ICP and accuracy as a tool for noninvasive surrogate ICP measurement in patients with decompressive craniotomy. Journal of Neurosurgery, pp. 1-7. doi:10.3171/2019.4.JNS183297.
Wang J, et al. Ultrasonographic Optic Nerve Sheath Diameter Correlation With ICP and Accuracy as a Tool for Noninvasive Surrogate ICP Measurement in Patients With Decompressive Craniotomy. J Neurosurg. 2019 Jul 19;1-7. PubMed PMID: 31323632.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrasonographic optic nerve sheath diameter correlation with ICP and accuracy as a tool for noninvasive surrogate ICP measurement in patients with decompressive craniotomy. AU - Wang,Juxiang, AU - Li,Ke, AU - Li,Hongjia, AU - Ji,Chengyi, AU - Wu,Ziyao, AU - Chen,Huimin, AU - Chen,Bin, Y1 - 2019/07/19/ PY - 2018/11/21/received PY - 2019/04/29/accepted PY - 2019/7/20/entrez PY - 2019/7/20/pubmed PY - 2019/7/20/medline KW - DC KW - DC = decompressive craniotomy KW - EVD = external ventricular drainage KW - GCS = Glasgow Coma Scale KW - ICP KW - ICP = intracranial pressure KW - ONSD KW - ONSD = optic nerve sheath diameter KW - ROC = receiver operating characteristic KW - TBI = traumatic brain injury KW - US-ONSD = ultrasonographic ONSD KW - decompressive craniotomy KW - intracranial pressure KW - optic nerve sheath diameter KW - trauma KW - traumatic brain injury KW - ultrasonography SP - 1 EP - 7 JF - Journal of neurosurgery JO - J. Neurosurg. N2 - OBJECTIVE: Increased intracranial pressure (ICP) results in enlarged optic nerve sheath diameter (ONSD). In this study the authors aimed to assess the association of ONSD and ICP in severe traumatic brain injury (TBI) after decompressive craniotomy (DC). METHODS: ONSDs were measured by ocular ultrasonography in 40 healthy control adults. ICPs were monitored invasively with a microsensor at 6 hours and 24 hours after DC operation in 35 TBI patients. ONSDs were measured at the same time in these patients. Patients were assigned to 3 groups according to ICP levels, including normal (ICP ≤ 13 mm Hg), mildly elevated (ICP = 14-22 mm Hg), and severely elevated (ICP > 22 mm Hg) groups. ONSDs were compared between healthy control adults and TBI cases with DC. Then, the association of ONSD with ICP was analyzed using Pearson's correlation coefficient, linear regression analysis, and receiver operator characteristic curves. RESULTS: Seventy ICP measurements were obtained among 35 TBI patients after DC, including 25, 27, and 18 measurements in the normal, mildly elevated, and severely elevated ICP groups, respectively. Mean ONSDs were 4.09 ± 0.38 mm in the control group and 4.92 ± 0.37, 5.77 ± 0.41, and 6.52 ± 0.44 mm in the normal, mildly elevated, and severely elevated ICP groups, respectively (p < 0.001). A significant linear correlation was found between ONSD and ICP (r = 0.771, p < 0.0001). Enlarged ONSD was a robust predictor of elevated ICP. With an ONSD cutoff of 5.48 mm (ICP > 13 mm Hg), sensitivity and specificity were 91.1% and 88.0%, respectively; a cutoff of 5.83 mm (ICP > 22 mm Hg) yielded sensitivity and specificity of 94.4% and 81.0%, respectively. CONCLUSIONS: Ultrasonographic ONSD is strongly correlated with invasive ICP measurements and may serve as a sensitive and noninvasive method for detecting elevated ICP in TBI patients after DC. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/31323632/Ultrasonographic_optic_nerve_sheath_diameter_correlation_with_ICP_and_accuracy_as_a_tool_for_noninvasive_surrogate_ICP_measurement_in_patients_with_decompressive_craniotomy_ L2 - https://thejns.org/doi/10.3171/2019.4.JNS183297 DB - PRIME DP - Unbound Medicine ER -