Skip to main content

Optic nerve sheath diameter on facial CT: a tool to predict traumatic brain injury

European Journal of Trauma and Emergency Surgery volume 46, pages 879–885 (2020)Cite this article

Abstract

Purpose

To evaluate and compare the optic nerve sheath diameters (ONSDs) of facial trauma patients as observed on facial CT and brain CT, and to evaluate the predictive performance of ONSD as seen on facial CT for traumatic brain injury (TBI).

Methods

We retrospectively enrolled 262 patients with facial trauma who underwent both facial CT and brain CT. Two reviewers independently measured ONSD at 3 mm (ONSD3) and 10 mm behind the globe (ONSD10) for each patient on both CT scans. Final CT reports with clinical progress notes were used as the reference standard. Statistically, multivariate logistic regression analysis, receiver operating characteristic (ROC) curves, and intraclass correlation coefficients (ICCs) were used.

Results

Eighty-seven (33.2%) patients were diagnosed with facial fracture, and 21 (8.0%) were diagnosed with intracranial haemorrhage. Neither reviewer observed significant differences (p = 0.15–0.61) between facial CT and brain CT when comparing ONSD3 and ONSD10. ONSD3 on facial CT was a significantly independent factor for distinguishing TBI from negative brain CT scan (p = 0.001); as ONSD3 increased, the risk of TBI increased 8.1-fold. ONSD3 ≥ 4.13 mm exhibited the highest area under the ROC curve (AUC) for predicting TBI (AUC, 0.968; sensitivity, 90.5%; specificity, 98.8%). There were good or excellent interobserver agreements for all measurements (ICC, 0.750–0.875).

Conclusion

ONSD3 as determined by facial CT is a feasible predictive marker of TBI in facial trauma patients. It can assist emergency physicians in deciding whether immediate further brain imaging is warranted.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Ghajar J. Traumatic brain injury. Lancet. 2000;356:923–9.

    CAS  Article  Google Scholar 

  2. Cole TB. Global road safety crisis remedy sought: 1.2 million killed, 50 million injured annually. JAMA. 2004;291:2531–2.

    CAS  Article  Google Scholar 

  3. Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2006.

    Google Scholar 

  4. Leitgeb J, Mauritz W, Brazinova A, Majdan M, et al. Impact of concomitant injuries on outcomes after traumatic brain injury. Arch Orthop Trauma Surg. 2013;133:659–68.

    Article  Google Scholar 

  5. Huang LK, Wang HH, Tu HF, Fu CY. Simultaneous head and facial computed tomography scans for assessing facial fractures in patients with traumatic brain injury. Injury. 2017;48:1417–22.

    Article  Google Scholar 

  6. Holmgren EP, Dierks EJ, Homer LD, Potter BE. Facial computed tomography use in trauma patients who require a head computed tomogram. J Oral Maxillofac Surg. 2004;62:913–8.

    Article  Google Scholar 

  7. Pappachan B, Alexander M. Correlating facial fractures and cranial injuries. J Oral Maxillofac Surg. 2006;64:1023–9.

    Article  Google Scholar 

  8. Zandi M, Hoseini SRS. The relationship between head injury and facial trauma: a case-control study. Oral Maxillofac Surg. 2013;17:201–7.

    Article  Google Scholar 

  9. Rajandram RK, Omar SNS, Rashdi MFN, Jabar MNA. Maxillofacial injuries and traumatic brain injury - a pilot study. Dent Traumatol. 2014;30:128–32.

    Article  Google Scholar 

  10. Kraus JF, Rice TM, Peek-Asa C, McArthur DL. Facial trauma and the risk of intracranial injury in motorcycle riders. Ann Emerg Med. 2003;41:18–26.

    Article  Google Scholar 

  11. Lee HJ, Kim YJ, Seo DW, Sohn CH, et al. Incidence of intracranial injury in orbital wall fracture patients not classified as traumatic brain injury. Injury. 2018;49:963–8.

    Article  Google Scholar 

  12. Hansen HC, Helmke K. The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath. Surg Radiol Anat. 1996;18:323–8.

    CAS  Article  Google Scholar 

  13. Helmke K, Hansen HC. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol. 1996;26:701–5.

    CAS  Article  Google Scholar 

  14. Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med. 2008;15:201–4.

    Article  Google Scholar 

  15. Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J. 2005;47:458–72.

    Article  Google Scholar 

  16. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    CAS  Article  Google Scholar 

  17. Puljula J, Cygnel H, Mäkinen E, Tuomivaara V, et al. Mild traumatic brain injury diagnosis frequently remains unrecorded in subjects with craniofacial fractures. Injury. 2012;43:2100–4.

    Article  Google Scholar 

  18. Powell JM, Ferraro JV, Dikmen SS, Temkin NR, et al. Accuracy of mild traumatic brain injury diagnosis. Arch Phys Med Rehabil. 2008;89:1550–5.

    Article  Google Scholar 

  19. National Council on Radiation Protection and Measurements. Scientific Committee 6 – 2 on Radiation Exposure of the U.S. Population. In: Ionizing radiation exposure of the population of the United States: recommendations of the National Council on Radiation Protection and Measurements. Report no. 160. Bethesda: National Council on Radiation Protection and Measurements; 2009.

    Google Scholar 

  20. Stein SC, Fabbri A, Servadei F, Glick HA. A critical comparison of clinical decision instruments for computed tomographic scanning in mild closed traumatic brain injury in adolescents and adults. Ann Emerg Med. 2009;53:180–8.

    Article  Google Scholar 

  21. Papa L, Stiell IG, Clement CM, Pawlowicz A, et al. Performance of the Canadian CT Head Rule and the New Orleans Criteria for predicting any traumatic intracranial injury on computed tomography in a United States level I trauma center. Acad Emerg Med. 2012;19:2–10.

    Article  Google Scholar 

  22. Tan DW, Lim AME, Ong DY, Peng LL, et al. Computed tomography of the head for adult patients with minor head injury: are clinical decision rules a necessary evil? Singap Med J. 2018;59:199–204.

    Article  Google Scholar 

  23. Legrand A, Jeanjean P, Delanghe F, Peltier J, et al. Estimation of optic nerve sheath diameter on an initial brain computed tomography scan can contribute prognostic information in traumatic brain injury patients. Crit Care. 2013;17:R61.

    Article  Google Scholar 

  24. Das SK, Shetty SP, Sen KK. A novel triage tool: optic nerve sheath diameter in traumatic brain injury and its correlation to Rotterdam computed tomography (CT) scoring. Pol J Radiol. 2017;82:240–3.

    Article  Google Scholar 

  25. Bekerman I, Sigal T, Kimiagar I, Vaiman M. Initial evaluation of the intracranial pressure in cases of traumatic brain injury without hemorrhage. J Neurol Sci. 2016;368:285–9.

    Article  Google Scholar 

  26. Lee SH, Yun SJ, Ryu S, Choi SW, et al. Brain computed tomography compared with facial 3-dimensional computed tomography for diagnosis of facial fractures. J Pediatr. 2017;184:32–7.e2.

    Article  Google Scholar 

  27. Ryu J, Yun SJ, Lee SH, Choi YH. Screening of pediatric facial fractures by brain computed tomography: diagnostic performance comparison with facial computed tomography. Pediatr Emerg Care. 2018. https://doi.org/10.1097/PEC.0000000000001397.

    Article  PubMed  Google Scholar 

  28. Lim D, Lee SH, Kim DH, Choi DS, et al. The possibility of application of spiral brain computed tomography to traumatic brain injury. Am J Emerg Med. 2014;32:1051–4.

    Article  Google Scholar 

  29. Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, et al. Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care. 2008;12:R67.

    Article  Google Scholar 

  30. Ballantyne SA, O’Neill G, Hamilton R, Hollman AS. Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound. 2002;15:145–9.

    CAS  Article  Google Scholar 

  31. Bäuerle J, Lochner P, Kaps M, Nedelmann M. Intra- and interobserver reliability of sonographic assessment of the optic nerve sheath diameter in healthy adults. J Neuroimaging. 2012;22:42–5.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Dr. Seokyong Ryu and Dr. Suk Jin Cho for assistance in analysing CT images.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea

    Sun Hwa Lee

  2. Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea

    Seong Jong Yun

Authors
  1. Sun Hwa Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seong Jong Yun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seong Jong Yun.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

This study has been approved by the ethics committee and has been performed in accordance with the ethical standards laid down in the Declaration of Helsinki. Due to the retrospective nature of the study, no informed consent was obtained from the included cohort as judged by the ethics committee.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lee, S.H., Yun, S.J. Optic nerve sheath diameter on facial CT: a tool to predict traumatic brain injury. Eur J Trauma Emerg Surg 46, 879–885 (2020). https://doi.org/10.1007/s00068-018-1035-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-018-1035-3

Keywords

  • Facial injury
  • Traumatic brain injury
  • Optic nerve sheath diameter
  • Computed tomography
  • Emergency medicine