title: Estimation of optic nerve sheath diameter on an initial brain computed tomography scan can contribute prognostic information in traumatic brain injury patients.
abstract: BACKGROUND
  The aim of this study was to evaluate the prognostic value of optic nerve sheath diameter (ONSD) measured on the initial brain computed tomography (CT) scan for intensive care unit (ICU) mortality in severe traumatic brain injury (TBI) patients.
  
  
  METHODS
  A prospective observational study of all severe TBI patients admitted to a neurosurgical ICU (over a 10-month period). Demographic and clinical data and brain CT scan results were recorded. ONSD for each eye was measured on the initial CT scan. The group of ICU survivors was compared to non-survivors. Glasgow Outcome Scale (GOS) was evaluated six months after ICU discharge.
  
  
  RESULTS
  Seventy-seven patients were included (age: 43±18; 81% males; mean Injury Severity Score: 35±15; ICU mortality: 28.5% (n=22)). Mean ONSD on the initial brain CT scan was 7.8±0.1 mm in non-survivors vs. 6.8±0.1 mm in survivors (P<0.001). The operative value of ONSD was a good predictor of mortality (area under the curve: 0.805). An ONSD cutoff≥7.3 had a sensitivity of 86.4% and a specificity of 74.6% and was independently associated with mortality in this population (adjusted odds ratio 95% confidence interval: 22.7 (3.2 to 159.6), P=0.002). There was a relationship between initial ONSD values and six-month GOS (P=0.03).
  
  
  CONCLUSIONS
  ONSD measured on the initial brain CT scan is independently associated with ICU mortality rate (when ≥7.3 mm) in severe TBI patients.See related commentary by Masquère et al.,http://ccforum.com/content/17/3/151.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Legrand
authors.forename: Patrick
authors.initials: P
authors.lastname: Jeanjean
authors.forename: Fanny
authors.initials: F
authors.lastname: Delanghe
authors.forename: Johann
authors.initials: J
authors.lastname: Peltier
authors.forename: Benoit
authors.initials: B
authors.lastname: Lecat
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009900:Optic Nerve / Q000000981:diagnostic imaging*; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards; D055815:Young Adult
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