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Ratio of Optic Nerve Sheath Diameter to Eyeball Transverse Diameter by Ultrasound Can Predict Intracranial Hypertension in Traumatic Brain Injury Patients: A Prospective Study

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A Response to a Letter To The Editor to this article was published on 04 September 2019

A Letter to the editor to this article was published on 29 August 2019

Abstract

Background

Measuring optic nerve sheath diameter (ONSD), an indicator to predict intracranial hypertension, is noninvasive and convenient, but the reliability of ONSD needs to be improved. Instead of using ONSD alone, this study aimed to evaluate the reliability of the ratio of ONSD to eyeball transverse diameter (ONSD/ETD) in predicting intracranial hypertension in traumatic brain injury (TBI) patients.

Methods

We performed a prospective study on patients admitted to the Surgery Intensive Care Unit. The included 52 adults underwent craniotomy for TBI between March 2017 and September 2018. The ONSD and ETD of each eyeball were measured by ultrasound and computed tomography (CT) scan within 24 h after a fiber optic probe was placed into lateral ventricle. Intracranial pressure (ICP) > 20 mmHg was regarded as intracranial hypertension. The correlations between invasive ICP and ultrasound-ONSD/ETD ratio, ultrasound-ONSD, CT-ONSD/ETD ratio, and CT-ONSD were each analyzed separately.

Results

Ultrasound measurement was successfully performed in 94% (n = 49) of cases, and ultrasound and CT measurement were performed in 48% (n = 25) of cases. The correlation efficiencies between ultrasound-ONSD/ETD ratio, ultrasound-ONSD, CT-ONSD/ETD ratio, and ICP were 0.613, 0.498, and 0.688, respectively (P < 0.05). The area under the curve (AUC) values of the receiver operating characteristic (ROC) curve for the ultrasound-ONSD/ETD ratio and CT-ONSD/ETD ratio were 0.920 (95% CI 0.877–0.964) and 0.896 (95% CI 0.856–0.931), respectively. The corresponding threshold values were 0.25 (sensitivity of 90%, specificity of 82.3%) and 0.25 (sensitivity of 85.7%, specificity of 83.3%), respectively.

Conclusion

The ratio of ONSD to ETD tested by ultrasound may be a reliable indicator for predicting intracranial hypertension in TBI patients.

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Abbreviations

ONSD:

Optic nerve sheath diameter

ICP:

Intracranial pressure

ETD:

Eyeball transverse diameter

SICU:

Surgery Intensive Care Unit

CT:

Computed tomography

AUC:

Area under curve

ROC:

Receiver operating characteristic

GCS:

Glasgow Coma Score

BMI:

Body mass index

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Funding

There was no funding associated with this study.

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Author notes

  1. Jie Du and Yanjun Deng contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, No. 1 Lijiang Road, Gaoxin District, Suzhou, 215153, Jiangsu Province, China

    Jie Du, Yanjun Deng, Hua Li, Shigang Qiao, Mengnan Yu, Qingya Xu & Chen Wang

  2. Institute of Clinical Medicine Research, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, No. 1 Lijiang Road, Gaoxin District, Suzhou, 215153, Jiangsu Province, China

    Shigang Qiao & Chen Wang

Authors
  1. Jie Du
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  2. Yanjun Deng
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  3. Hua Li
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  4. Shigang Qiao
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  5. Mengnan Yu
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  6. Qingya Xu
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  7. Chen Wang
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Contributions

JD, YD, and CW conceived and designed the study. HL, MY, and QX performed the experiments and analyzed the data. JD, YD wrote the paper. YD, SQ, and CW reviewed and edited the manuscript. All authors discussed the results and approved the manuscript.

Corresponding author

Correspondence to Chen Wang.

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The authors declared that they have no conflicts of interest to this work.

Ethical Approval/Informed Consent

This study was conducted according to our institution’s guidelines for ethical research. Institutional review board approval was obtained for this study (IRB2019007).

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Du, J., Deng, Y., Li, H. et al. Ratio of Optic Nerve Sheath Diameter to Eyeball Transverse Diameter by Ultrasound Can Predict Intracranial Hypertension in Traumatic Brain Injury Patients: A Prospective Study. Neurocrit Care 32, 478–485 (2020). https://doi.org/10.1007/s12028-019-00762-z

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