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



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.


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.


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 (R 2 of 0.56) compared to other CT features (R 2 of 0.21).


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.


Optic nerve sheath diameter Computed tomography Traumatic brain injury Intracranial pressure 



We would like to acknowledge the staff of the Neurocritical Care Unit at Addenbrooke’s Hospital for their support in the completion of this study.

Conflicts of interest

The ICM+ brain monitoring software ( is licensed by the University of Cambridge. Dr. Czosnyka and Dr. Smielewski have a financial interest in the licensing fee.

Ethical standard

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Mypinder S. Sekhon
    • 1
    • 2
    Email author
  • 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

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