Intensive Care Medicine

, Volume 37, Issue 7, pp 1059–1068

Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis

  • Julie Dubourg
  • Etienne Javouhey
  • Thomas Geeraerts
  • Mahmoud Messerer
  • Behrouz Kassai

DOI: 10.1007/s00134-011-2224-2

Cite this article as:
Dubourg, J., Javouhey, E., Geeraerts, T. et al. Intensive Care Med (2011) 37: 1059. doi:10.1007/s00134-011-2224-2



To evaluate the diagnostic accuracy of ultrasonography of optic nerve sheath diameter (ONSD) for assessment of intracranial hypertension.


Systematic review without language restriction based on electronic databases, with manual review of literature and conference proceedings until July 2010. Studies were eligible if they compared ultrasonography of ONSD with intracranial pressure (ICP) monitoring. Data were extracted independently by three authors. Random-effects meta-analysis and meta-regression were performed.


Six studies including 231 patients were reviewed. No significant heterogeneity was detected for sensitivity, specificity, positive and negative likelihood ratios or diagnostic odds ratio. For detection of raised intracranial pressure, pooled sensitivity was 0.90 [95% confidence interval (CI) 0.80–0.95; p for heterogeneity, phet = 0.09], pooled specificity was 0.85 (95% CI 0.73–0.93, phet = 0.13), and the pooled diagnostic odds ratio was 51 (95% CI 22–121). The area under the summary receiver-operating characteristic (SROC) curve was 0.94 (95% CI 0.91–0.96).


Ultrasonography of ONSD shows a good level of diagnostic accuracy for detecting intracranial hypertension. In clinical decision-making, this technique may help physicians decide to transfer patients to specialized centers or to place an invasive device when specific recommendations for this placement do not exist.


Intracranial hypertensionOptic nerve sheath diameterUltrasonographyMeta-analysisSystematic reviewAccuracy

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Julie Dubourg
    • 1
  • Etienne Javouhey
    • 2
  • Thomas Geeraerts
    • 3
  • Mahmoud Messerer
    • 4
  • Behrouz Kassai
    • 1
  1. 1.Inserm, CIC201, Service de Pharmacologie Clinique, EPICIME, Groupement Hospitalier Est, Hospices Civils de LyonUniversité Claude Bernard Lyon 1LyonFrance
  2. 2.Service de Réanimation Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de LyonUniversité Claude Bernard Lyon 1LyonFrance
  3. 3.Service d’Anesthésie et de Réanimation, Hôpital Purpan, CHU ToulouseUniversité Paul SabatierToulouseFrance
  4. 4.Service de Neurochirurgie A, Hôpital Neurologique Pierre Wertheimer, CHU LyonUniversité Claude BernardLyonFrance