https://doi.org/10.4081/ecj.2023.11333

Accuracy of bedside sonographic measurement of optic nerve sheath diameter for intracranial hypertension diagnosis in the emergency department

Vol. 19 No. 2 (2023): In Memory of Barbara Capovani
Submitted: 23 March 2023
Accepted: 8 May 2023
Published: 23 June 2023
Optic nerve, ultrasound optic nerve sheet diameter (US ONSD), ultrasound, intracranial hypertension, traumatic brain injury, non traumatic brain injury
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Authors

Chiara Busti
chiara.busti@gmail.com
Emergency Department, Gubbio and Gualdo Tadino Hospital, Gubbi, Italy.
Matteo Marcosignori
Emergency Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti delle Marche, Ancona, Italy.
Francesco Marchetti
Radiology Department, Santa Maria della Misericordia Hospital, Perugia, Italy.
Giuseppe Batori
Internal Medicine, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
Laura Giovenali
Emergency Medicine Residency Program, Marche Polytechnic University, Ancona, Italy.
Francesco Corea
Neurology Department, San Giovanni Battista Hospital, Foligno, Italy.
Giuseppe Calabrò
Emergency Department, San Giovanni Battista Hospital, Foligno, Italy.
Manuel Monti
https://orcid.org/0000-0003-0478-110X
Emergency Department, Gubbio and Gualdo Tadino Hospital, Gubbio, Italy.
Federico Germini
https://orcid.org/0000-0002-0802-3616
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada.

Ultrasound measurement of the optic nerve sheath diameter (US ONSD) has been proposed as a method to diagnose elevated intracranial pressure (EICP), but the optimal threshold is unclear. The aim of this study was to assess the accuracy of US ONSD, as compared to head computed tomography (CT), in detecting EICP of both traumatic and non-traumatic origin. We conducted a prospective, cross-sectional, multicenter study. Patients presenting to the emergency department with a suspect of traumatic or non-traumatic brain injury, referred for an urgent head CT, underwent US ONSD measurement. A US ONSD ≥5.5 mm was considered positive. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for three ONSD cut-offs: 5.5 (primary outcome), 5.0, and 6.0 mm. A receiver operating characteristic (ROC) curve was also generated and the area under the ROC curve calculated. Ninetynine patients were enrolled. The CT was positive in 15% of cases and the US ONSD was positive in all of these, achieving a sensitivity of 100% [95% confidence interval (CI) 78; 100] and a negative predictive value of 100% (95% CI 79; 100). The CT was negative in 85% of cases, while the US ONSD was positive in 69% of these, achieving a specificity of 19% (95% CI 11; 29) and a positive predictive value of 18% (95% CI 11; 28). The US ONSD, with a 5.5 mm cut-off, might safely be used to rule out EICP in patients with traumatic and non-traumatic brain injury in the ED. In limited-resources contexts, a negative US ONSD could allow emergency physicians to rule out EICP in low-risk patients, deferring the head CT.

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How to Cite

Busti, C., Marcosignori , M., Marchetti , F., Batori , G., Giovenali , L., Corea , F., Calabrò , G., Monti, M., & Germini , F. (2023). Accuracy of bedside sonographic measurement of optic nerve sheath diameter for intracranial hypertension diagnosis in the emergency department. Emergency Care Journal, 19(2). https://doi.org/10.4081/ecj.2023.11333
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