Publication: Correlation between Invasive Intracranial Pressure Monitoring and Optic Nerve Sheath Diameter in Patients with Traumatic Brain Injury
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
In management of patients with traumatic brain injury, intracranial pressure holds
an important place. Any untoward rise in intracranial pressure portends dreaded
complications. Hence, any delay in detecting the issue is considered unacceptable.
Objective
This study focuses on analyzing the correlation between ultrasound derived optic
nerve sheath diameter and intracranial pressure values derived from invasive
intracranial pressure monitoring system in a neurosurgical patient with severe
traumatic brain injury.
Method
A prospective observational study was performed using a convenience sample
technique including all adult patients with traumatic brain injury who had invasive
intracranial monitors placed as part of their clinical care. Ocular ultrasound was
performed with 5 - 7.5 MHz linear probe of ACUSON X300 ultrasound system while
simultaneous intracranial pressure readings were obtained directly from an invasive
intracranial pressure monitoring system. The association between optic nerve sheath
diameter and invasive intracranial pressure reading was assessed with the Pearson’s
correlation coefficient and a receiver operator characteristic curve was created to
determine the optimal optic nerve sheath diameter cutoff to detect intracranial
pressure > 15 mm of Hg.
Result
One hundred and fifteen ocular ultrasounds were performed on 30 individual
patients. The mean age of the population involved in this study is 42.13 years ± 1.89
with male preponderance in the ratio of 6:1. Pearson’s correlation coefficient of
optic nerve sheath diameter and intracranial pressure was found to be 0.844 (p <
0.000) demonstrating a significant positive correlation. The area under the receiver
operating characteristic curve was found to be 0.961 (95% confidence interval = 0.93
to 0.99). Based on analysis of the receiver operating characteristic curve, optic nerve
sheath diameter > 4.85 mm performed best to detect intracranial pressure > 15 mm
of Hg. with a sensitivity of 93.5% and specificity of 83%.
Conclusion
Optic nerve sheath diameter is a dependable screening tool to evaluate for elevated
intracranial pressure among patients with traumatic nerve injury.
KEY WORDS
Intracranial pressure, Optic nerve sheath diameter, Screening
Description
Shrestha B,1 Shrestha P,2 Ghale P,2 Lakshmipathy G2
1Department of Surgery -Neurosurgery Unit
Dhulikhel Hospital, Kathmandu University Hospital,
Kathmandu University School of Medical Sciences,
Dhulikhel, Kavre, Nepal
2Department of Neurosurgery
Upendra Devkota Memorial National Institute
of Neurological and Allied Sciences,
Bansbari, Kathmandu, Nepal
Keywords
Intracranial pressure, Optic nerve sheath diameter, Screening