title: Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients.
abstract: OBJECTIVE
  Our objective is to determine whether a bedside ultrasonographic measurement of optic nerve sheath diameter can accurately predict the computed tomographic (CT) findings of elevated intracranial pressure in adult head injury patients in the emergency department (ED).
  
  
  METHODS
  We conducted a prospective, blinded observational study on adult ED patients with suspected intracranial injury with possible elevated intracranial pressure. Exclusion criteria were age younger than 18 years or obvious ocular trauma. Using a 7.5-MHz ultrasonographic probe on the closed eyelids, a single optic nerve sheath diameter was measured 3 mm behind the globe in each eye. A mean binocular optic nerve sheath diameter greater than 5.00 mm was considered abnormal. Cranial CT findings of shift, edema, or effacement suggestive of elevated intracranial pressure were used to evaluate optic nerve sheath diameter accuracy.
  
  
  RESULTS
  Fifty-nine patients were enrolled in the study. Average age was 38 years, and median Glasgow Coma Scale score was 15 (interquartile 6 to 15). Eight patients with an optic nerve sheath diameter of 5.00 mm or more had CT findings that correlated with elevated intracranial pressure. The sensitivity for the ultrasonography in detecting elevated intracranial pressure was 100% (95% confidence interval [CI] 68% to 100%) and specificity was 63% (95% CI 50% to 76%). The sensitivity of ultrasonography for detection of any traumatic intracranial injury found by CT was 84% (95% CI 60% to 97%) and specificity was 73% (95% CI 59% to 86%).
  
  
  CONCLUSIONS
  Bedside ED optic nerve sheath diameter ultrasonography has potential as a sensitive screening test for elevated intracranial pressure in adult head injury.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA. vtayal@carolinas.org
authors.forename: Vivek S
authors.initials: VS
authors.lastname: Tayal
authors.forename: Matthew
authors.initials: M
authors.lastname: Neulander
authors.forename: H James
authors.initials: HJ
authors.lastname: Norton
authors.forename: Troy
authors.initials: T
authors.lastname: Foster
authors.forename: Timothy
authors.initials: T
authors.lastname: Saunders
authors.forename: Michael
authors.initials: M
authors.lastname: Blaivas
mesh_terms: D000328:Adult; D006259:Craniocerebral Trauma / Q000150:complications / Q000503:physiopathology*; D004636:Emergency Service, Hospital; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000209:etiology; D007427:Intracranial Pressure; D009900:Optic Nerve / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography