Abstract
Purpose
To evaluate the diagnostic accuracy of ultrasonography of optic nerve sheath diameter (ONSD) for assessment of intracranial hypertension.
Methods
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.
Results
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, p het = 0.09], pooled specificity was 0.85 (95% CI 0.73–0.93, p het = 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).
Conclusions
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.
Similar content being viewed by others
References
Guillaume J, Janny P (1951) Continuous intracranial manometry; physiopathologic and clinical significance of the method. Presse Med 59:953–955
Lundberg N (1960) Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl 36:1–193
Rickert K, Sinson G (2003) Intracranial pressure monitoring. Oper Tech Gen Surg 5:170–175
The brain trauma foundation. The american association of neurological surgeons. The joint section on neurotrauma, critical care (2000) Recommendations for intracranial pressure monitoring technology. J Neurotrauma 17:497–506
Wilberger JE Jr (1997) Outcomes analysis: intracranial pressure monitoring. Clin Neurosurg 44:439–448
Paramore CG, Turner DA (1994) Relative risks of ventriculostomy infection and morbidity. Acta Neurochir (Wien) 127:79–84
Winkler F, Kastenbauer S, Yousry TA, Maerz U, Pfister HW (2002) Discrepancies between brain CT imaging and severely raised intracranial pressure proven by ventriculostomy in adults with pneumococcal meningitis. J Neurol 249:1292–1297
Hiler M, Czosnyka M, Hutchinson P, Balestreri M, Smielewski P, Matta B, Pickard JD (2006) Predictive value of initial computerized tomography scan, intracranial pressure, and state of autoregulation in patients with traumatic brain injury. J Neurosurg 104:731–737
Hassler W, Steinmetz H, Gawlowski J (1988) Transcranial doppler ultrasonography in raised intracranial pressure and in intracranial circulatory arrest. J Neurosurg 68:745–751
Schmidt B, Czosnyka M, Raabe A, Yahya H, Schwarze JJ, Sackerer D, Sander D, Klingelhofer J (2003) Adaptive noninvasive assessment of intracranial pressure and cerebral autoregulation. Stroke 34:84–89
Aaslid R, Huber P, Nornes H (1986) A transcranial doppler method in the evaluation of cerebrovascular spasm. Neuroradiology 28:11–16
Durham B (1996) Emergency medicine physicians saving time with ultrasound. Am J Emerg Med 14:309–313
Antonelli M, Azoulay E, Bonten M, Chastre J, Citerio G, Conti G, De Backer D, Lemaire F, Gerlach H, Groeneveld J, Hedenstierna G, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Metnitz P, Pugin J, Wernerman J, Zhang H (2009) Year in review in intensive care medicine, 2008: I. Brain injury and neurology, renal failure and endocrinology, metabolism and nutrition, sepsis, infections and pneumonia. Intensive Care Med 35:30–44
Galetta S, Byrne SF, Smith JL (1989) Echographic correlation of optic nerve sheath size and cerebrospinal fluid pressure. J Clin Neuroophthalmol 9:79–82
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 87:34–40
Hansen HC, Helmke K (1996) The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath. Surg Radiol Anat 18:323–328
Blaivas M, Theodoro D, Sierzenski PR (2003) Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med 10:376–381
Helmke K, Hansen HC (1996) Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension ii. Patient study. Pediatr Radiol 26:706–710
Helmke K, Hansen HC (1996) Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol 26:701–705
Kassai B, Sonie S, Shah NR, Boissel JP (2006) Literature search parameters marginally improved the pooled estimate accuracy for ultrasound in detecting deep venous thrombosis. J Clin Epidemiol 59:710–714
Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2003) The development of quadas: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25
Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM (2003) The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 56:1129–1135
Littenberg B, Moses LE (1993) Estimating diagnostic accuracy from multiple conflicting reports: a new meta-analytic method. Med Decis Making 13:313–321
Fleiss J (1981) Statistical methods for rates and proportions, 2nd edn. Wiley, New York
Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558
Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH (2005) Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 58:982–990
Swets JA (1988) Measuring the accuracy of diagnostic systems. Science 240:1285–1293
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634
Deeks JJ, Macaskill P, Irwig L (2005) The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 58:882–893
Baker WL, White CM, Cappelleri JC, Kluger J, Coleman CI (2009) Understanding heterogeneity in meta-analysis: the role of meta-regression. Int J Clin Pract 63:1426–1434
Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A (2006) Meta-disc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 6:31
Beare NA, Kampondeni S, Glover SJ, Molyneux E, Taylor TE, Harding SP, Molyneux ME (2008) Detection of raised intracranial pressure by ultrasound measurement of optic nerve sheath diameter in African children. Trop Med Int Health 13:1400–1404
Brzezinska R, Schumacher R (2002) Diagnosis of elevated intracranial pressure in children with shunt under special consideration of transglobe sonography of the optic nerve. Ultraschall Med 23:325–332
Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Camargo CA Jr, Harris NS (2009) Optic nerve sheath diameter correlates with the presence and severity of acute mountain sickness: evidence for increased intracranial pressure. J Appl Physiol 106:1207–1211
Girisgin AS, Kalkan E, Kocak S, Cander B, Gul M, Semiz M (2007) The role of optic nerve ultrasonography in the diagnosis of elevated intracranial pressure. Emerg Med J 24:251–254
Goel RS, Goyal NK, Dharap SB, Kumar M, Gore MA (2008) Utility of optic nerve ultrasonography in head injury. Injury 39:519–524
Korber F, Scharf M, Moritz J, Dralle D, Alzen G (2005) Sonography of the optical nerve experience in 483 children. Rofo 177:229–235
Malayeri AA, Bavarian S, Mehdizadeh M (2005) Sonographic evaluation of optic nerve diameter in children with raised intracranial pressure. J Ultrasound Med 24:143–147
McAuley D, Paterson A, Sweeney L (2009) Optic nerve sheath ultrasound in the assessment of paediatric hydrocephalus. Childs Nerv Syst 25:87–90
Newman WD, Hollman AS, Dutton GN, Carachi R (2002) Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol 86:1109–1113
Salgarello T, Tamburrelli C, Falsini B, Giudiceandrea A, Colotto A (1996) Optic nerve diameters and perimetric thresholds in idiopathic intracranial hypertension. Br J Ophthalmol 80:509–514
Shuper A, Snir M, Barash D, Yassur Y, Mimouni M (1997) Ultrasonography of the optic nerves: clinical application in children with pseudotumor cerebri. J Pediatr 131:734–740
Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M (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 49:508–514
Tsung JW, Blaivas M, Cooper A, Levick NR (2005) A rapid noninvasive method of detecting elevated intracranial pressure using bedside ocular ultrasound: application to 3 cases of head trauma in the pediatric emergency department. Pediatr Emerg Care 21:94–98
Sutherland AI, Morris DS, Owen CG, Bron AJ, Roach RC (2008) Optic nerve sheath diameter, intracranial pressure and acute mountain sickness on mount everest: a longitudinal cohort study. Br J Sports Med 42:183–188
Watanabe A, Kinouchi H, Horikoshi T, Uchida M, Ishigame K (2008) Effect of intracranial pressure on the diameter of the optic nerve sheath. J Neurosurg 109:255–258
Le A, Hoehn ME, Smith ME, Spentzas T, Schlappy D, Pershad J (2009) Bedside sonographic measurement of optic nerve sheath diameter as a predictor of increased intracranial pressure in children. Ann Emerg Med 53:785–791
Geeraerts T, Launey Y, Martin L, Pottecher J, Vigue B, Duranteau J, Benhamou D (2007) Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med 33:1704–1711
Geeraerts T, Merceron S, Benhamou D, Vigue B, Duranteau J (2008) Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med 34:2062–2067
Kimberly HH, Shah S, Marill K, Noble V (2008) Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 15:201–204
Moretti R, Pizzi B (2009) Optic nerve ultrasound for detection of intracranial hypertension in intracranial hemorrhage patients: confirmation of previous findings in a different patient population. J Neurosurg Anesthesiol 21:16–20
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 11:406–410
Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabinis A (2008) Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care 12:R67
Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, Manley GT, Nemecek A, Newell DW, Rosenthal G, Schouten J, Shutter L, Timmons SD, Ullman JS, Videtta W, Wilberger JE, Wright DW (2007) Guidelines for the management of severe traumatic brain injury. Vi. Indications for intracranial pressure monitoring. J Neurotrauma 24 Suppl 1:S37–S44
Fagan TJ (1975) Letter: nomogram for bayes theorem. N Engl J Med 293:257
Bauerle J, Lochner P, Kaps M, Nedelmann M (2010) Intra- and interobsever reliability of sonographic assessment of the optic nerve sheath diameter in healthy adults. J Neuroimaging (epub ahead of print)
Patel HC, Bouamra O, Woodford M, King AT, Yates DW, Lecky FE (2005) Trends in head injury outcome from 1989 to 2003 and the effect of neurosurgical care: an observational study. Lancet 366:1538–1544
MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, Salkever DS, Scharfstein DO (2006) A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 354:366–378
Thornton A, Lee P (2000) Publication bias in meta-analysis: its causes and consequences. J Clin Epidemiol 53:207–216
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is discussed in the editorial available at: doi:10.1007/s00134-011-2226-0.
Rights and permissions
About this article
Cite this article
Dubourg, J., Javouhey, E., Geeraerts, T. et al. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med 37, 1059–1068 (2011). https://doi.org/10.1007/s00134-011-2224-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-011-2224-2