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Intensive Care Medicine
Published in: Intensive Care Medicine 9/2014

01-09-2014 | Original

Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury

Authors: Mypinder S. Sekhon, Donald E. Griesdale, Chiara Robba, Nick McGlashan, Edward Needham, Katherine Walland, Alyssa C. Shook, Peter Smielewski, Marek Czosnyka, Arun K. Gupta, David K. Menon

Published in: Intensive Care Medicine | Issue 9/2014

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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.
Appendix
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Metadata
Title
Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury
Authors
Mypinder S. Sekhon
Donald E. Griesdale
Chiara Robba
Nick McGlashan
Edward Needham
Katherine Walland
Alyssa C. Shook
Peter Smielewski
Marek Czosnyka
Arun K. Gupta
David K. Menon
Publication date
01-09-2014
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 9/2014
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-014-3392-7

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