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.
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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 (http://www.neurosurg.cam.ac.uk/icmplus) is licensed by the University of Cambridge. Dr. Czosnyka and Dr. Smielewski have a financial interest in the licensing fee.
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.
Take-home message: Optic nerve sheath diameter measured on head computed tomography is correlated with intracranial pressure. Increased optic nerve sheath diameter is a more sensitive and specific predictor of increased intracranial pressure than classical CT findings suggestive of intracranial hypertension.
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Sekhon, M.S., Griesdale, D.E., Robba, C. et al. Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury. Intensive Care Med 40, 1267–1274 (2014). https://doi.org/10.1007/s00134-014-3392-7
- Optic nerve sheath diameter
- Computed tomography
- Traumatic brain injury
- Intracranial pressure