Intensive Care Medicine

, Volume 40, Issue 9, pp 1267–1274 | Cite as

Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury

  • Mypinder S. Sekhon
  • Donald E. Griesdale
  • Chiara Robba
  • Nick McGlashan
  • Edward Needham
  • Katherine Walland
  • Alyssa C. Shook
  • Peter Smielewski
  • Marek Czosnyka
  • Arun K. Gupta
  • David K. Menon
Original

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 (R2 of 0.56) compared to other CT features (R2 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.

Keywords

Optic nerve sheath diameter Computed tomography Traumatic brain injury Intracranial pressure 

Supplementary material

134_2014_3392_MOESM1_ESM.doc (43 kb)
Supplementary material 1 (DOC 43 kb)
134_2014_3392_MOESM2_ESM.jpg (2.5 mb)
Supplementary material 2 (JPEG 3,303 kb)

References

  1. 1.
    Myburgh JA, Cooper DJ, Finfer SR et al (2008) Epidemiology and 12-month outcomes from traumatic brain injury in Australia and New Zealand. J Trauma 64:854–862PubMedCrossRefGoogle Scholar
  2. 2.
    Juul N, Morris GF, Marshall SB, Marshall LF (2000) Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial. J Neurosurg 92:1–6PubMedCrossRefGoogle Scholar
  3. 3.
    Vik A, Nag T, Fredriksli OA et al (2008) Relationship of “dose” of intracranial hypertension to outcome in severe traumatic brain injury. J Neurosurg 109:678–684PubMedCrossRefGoogle Scholar
  4. 4.
    Treggiari MM, Schutz N, Yanez ND, Romand J-A (2007) Role of intracranial pressure values and patterns in predicting outcome in traumatic brain injury: a systematic review. Neurocrit Care 6:104–112PubMedCrossRefGoogle Scholar
  5. 5.
    Balestreri M, Czosnyka M, Hutchinson P et al (2006) Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury. Neurocrit Care 4:8–13PubMedCrossRefGoogle Scholar
  6. 6.
    Chesnut RM, Marshall LF, Klauber MR et al (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34:216–222PubMedCrossRefGoogle Scholar
  7. 7.
    Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care (AANS/CNS) et al (2007) Guidelines for the management of severe traumatic brain injury. I. Blood pressure and oxygenation. J Neurotrauma 24 Suppl 1:S7–S13Google Scholar
  8. 8.
    Hiler M, Czosnyka M, Hutchinson P et al (2006) Predictive value of initial computerized tomography scan, intracranial pressure, and state of autoregulation in patients with traumatic brain injury. J Neurosurg 104:731–737PubMedCrossRefGoogle Scholar
  9. 9.
    Miller MT, Pasquale M, Kurek S et al (2004) Initial head computed tomographic scan characteristics have a linear relationship with initial intracranial pressure after trauma. J Trauma 56:967–972. Discussion 972–973PubMedCrossRefGoogle Scholar
  10. 10.
    Czosnyka M, Pickard JD (2004) Monitoring and interpretation of intracranial pressure J Neurol Neurosurg Psychiatry 75:813–821Google Scholar
  11. 11.
    Chesnut RM, Temkin N, Carney N et al (2012) A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 367:2471–2481PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Stocchetti N, Picetti E, Berardino M et al (2014) Clinical applications of intracranial pressure monitoring in traumatic brain injur: report of the Milan consensus conference. Acta Neurochir. doi:10.1007/s00701-014-2127-4
  13. 13.
    Kimberly HH, Noble VE (2008) Using MRI of the optic nerve sheath to detect elevated intracranial pressure. Crit Care 12:181PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Launey Y, Nesseler N, Le Maguet P et al (2014) Effect of osmotherapy on optic nerve sheath diameter in patients with increased intracranial pressure. J Neurotrauma 31:984–988PubMedCrossRefGoogle Scholar
  15. 15.
    Helmke K, Hansen HC (1996) Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol 26:701–705PubMedCrossRefGoogle Scholar
  16. 16.
    Hansen HC, Helmke K (1997) Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg 87:34–40PubMedCrossRefGoogle Scholar
  17. 17.
    Soldatos T, Karakitsos D, Chatzimichail K et al (2008) Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care 12:R67PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Cammarata G, Ristagno G, Cammarata A et al (2011) Ocular ultrasound to detect intracranial hypertension in trauma patients. J Trauma 71:779–781PubMedCrossRefGoogle Scholar
  19. 19.
    Blaivas M, Theodoro D, Sierzenski PR (2003) Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med 10:376–381PubMedCrossRefGoogle Scholar
  20. 20.
    Tayal VS, Neulander M, Norton HJ et al (2007) Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 49:508–514PubMedCrossRefGoogle Scholar
  21. 21.
    Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL (2011) Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 15:506–515PubMedCrossRefGoogle Scholar
  22. 22.
    Geeraerts T, Launey Y, Martin L et al (2007) Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med 33:1704–1711PubMedCrossRefGoogle Scholar
  23. 23.
    Geeraerts T, Merceron S, Benhamou D et al (2008) Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med 34:2062–2067PubMedCrossRefGoogle Scholar
  24. 24.
    Kimberly HH, Shah S, Marill K, Noble V (2008) Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 15:201–204PubMedCrossRefGoogle Scholar
  25. 25.
    Moretti R, Pizzi B (2011) Ultrasonography of the optic nerve in neurocritically ill patients. Acta Anaesthesiol Scand 55:644–652PubMedCrossRefGoogle Scholar
  26. 26.
    Dubourg J, Javouhey E, Geeraerts T et al (2011) Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med 37:1059–1068PubMedCrossRefGoogle Scholar
  27. 27.
    Moretti R, Pizzi B, Cassini F, Vivaldi N (2009) Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care 11:406–410PubMedCrossRefGoogle Scholar
  28. 28.
    Ballantyne SA, O’Neill G, Hamilton R, Hollman AS (2002) Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound 15:145–149PubMedCrossRefGoogle Scholar
  29. 29.
    Geeraerts T, Newcombe VFJ, Coles JP et al (2008) Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. Crit Care 12:R114PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Kalantari H, Jaiswal R, Bruck I et al (2013) Correlation of optic nerve sheath diameter measurements by computed tomography and magnetic resonance imaging. Am J Emerg Med 31:1595–1597PubMedCrossRefGoogle Scholar
  31. 31.
    Legrand A, Jeanjean P, Delanghe F et al (2013) Estimation of optic nerve sheath diameter on an initial brain computed tomography scan can contribute prognostic information in traumatic brain injury patients. Crit Care 17:R61PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Bratton SL, Chestnut RM, Ghajar J et al (2007) Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds. J Neurotrauma 24(Suppl 1):S55–S58PubMedGoogle Scholar
  33. 33.
    Vandenbroucke JP, von Elm E, Altman DG et al (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology 18:805–835PubMedCrossRefGoogle Scholar
  34. 34.
    Radolovich DK, Aries MJH, Castellani G et al (2011) Pulsatile intracranial pressure and cerebral autoregulation after traumatic brain injury. Neurocrit Care 15:379–386PubMedCrossRefGoogle Scholar
  35. 35.
    Maas AIR, Hukkelhoven CWPM, Marshall LF, Steyerberg EW (2005) Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery 57:1173–1182; discussion 1173–82PubMedCrossRefGoogle Scholar
  36. 36.
    Patel HC, Menon DK, Tebbs S et al (2002) Specialist neurocritical care and outcome from head injury. Intensive Care Med 28:547–553PubMedCrossRefGoogle Scholar
  37. 37.
    Rumboldt Z, Huda W, All JW (2009) Review of portable CT with assessment of a dedicated head CT scanner. AJNR Am J Neuroradiol 30:1630–1636PubMedCrossRefGoogle Scholar
  38. 38.
    Czosnyka M, Pickard JD (2004) Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry 75:813–821PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Mypinder S. Sekhon
    • 1
    • 2
  • Donald E. Griesdale
    • 1
    • 3
    • 4
  • Chiara Robba
    • 2
  • Nick McGlashan
    • 2
  • Edward Needham
    • 2
  • Katherine Walland
    • 2
  • Alyssa C. Shook
    • 5
  • Peter Smielewski
    • 2
  • Marek Czosnyka
    • 2
  • Arun K. Gupta
    • 2
  • David K. Menon
    • 2
  1. 1.Division of Critical Care Medicine, Department of Medicine, Vancouver General HospitalUniversity of British ColumbiaVancouverCanada
  2. 2.Neurocritical Care Unit, Addenbrooke’s HospitalCambridge University, Cambridge University Hospitals TrustCambridgeUK
  3. 3.Department of Anaesthesiology, Pharmacology and Therapeutics, Vancouver General HospitalUniversity of British ColumbiaVancouverCanada
  4. 4.Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research InstituteUniversity of British ColumbiaVancouverCanada
  5. 5. The Heart CentreSt. Paul’s HospitalVancouverCanada

Personalised recommendations