| Sonographic optic nerve sheath diameter as an estimate of intracranial pressure in adult trauma. | |
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MedLine Citation:
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PMID: 21550065 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Intracranial pressure (ICP) is currently measured with invasive monitoring. Sonographic optic nerve sheath diameter (ONSD) may provide a noninvasive estimate of ICP. Our hypothesis was that bedside ONSD accurately estimates ICP in acutely injured patients. The specific aims were (1) to determine the accuracy of ONSD in estimating elevated ICP, (2) to correlate ONSD and ICP in unilateral and bilateral head injuries, and (3) to determine the effect of ICP monitor placement on ONSD measurements. MATERIALS AND METHODS: A blinded prospective study of adult trauma patients requiring ICP monitoring was performed at a University-based urban trauma center. The ONSD was measured by ultrasound pre- and post-placement of an ICP monitor (Camino Bolt or Ventriculostomy). RESULTS: One-hundred fourteen measurements were obtained in 10 trauma patients requiring ICP monitoring. Pre- and post-ONSD were compared with side of injury in the presence of an ICP monitor. ROC analysis demonstrated ONSD poorly estimates elevated ICP (AUC = 0.36). Overall sensitivity, specificity, PPV, NPV, and accuracy for estimating ICP with ONSD were 36%, 38%, 40%, 16%, and 37%. Poor correlation of ONSD to ICP was observed with unilateral (R(2) = 0.45, P < 0.01) and bilateral (R(2) = 0.21, P = 0.01) injuries. ICP monitor placement did not affect ONSD measurements on the right (P = 0.5), left (P = 0.4), or right and left sides combined (P = 0.3). CONCLUSIONS: Sonographic ONSD as a surrogate for elevated ICP in lieu of invasive monitoring is not reliable due to poor accuracy and correlation. |
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Authors:
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Aaron Strumwasser; Rita O Kwan; Louise Yeung; Emily Miraflor; Alex Ereso; Frederico Castro-Moure; Atul Patel; Javid Sadjadi; Gregory P Victorino |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Validation Studies Date: 2011-04-01 |
Journal Detail:
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Title: The Journal of surgical research Volume: 170 ISSN: 1095-8673 ISO Abbreviation: J. Surg. Res. Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-09-16 Completed Date: 2011-11-15 Revised Date: 2012-03-15 |
Medline Journal Info:
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Nlm Unique ID: 0376340 Medline TA: J Surg Res Country: United States |
Other Details:
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Languages: eng Pagination: 265-71 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Surgery, University of California, San Francisco-East Bay, Oakland, California, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Brain Injuries / ultrasonography* Female Humans Intracranial Hypertension / ultrasonography* Intracranial Pressure* Male Middle Aged Monitoring, Physiologic Optic Nerve / ultrasonography* Predictive Value of Tests Prospective Studies ROC Curve Reproducibility of Results Sensitivity and Specificity Ultrasonography / methods, standards* |
| Comments/Corrections | |
Comment In:
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J Surg Res. 2012 Mar;173(1):e43-4; author reply e44-5
[PMID:
22221601
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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