title: Better prognostic value with combined optic nerve sheath diameter and grey-to-white matter ratio on initial brain computed tomography in post-cardiac arrest patients.
abstract: We aimed to evaluate the prognostic value of optic nerve sheath diameter (ONSD) and grey-to-white matter (GWR) either alone or in combination in patients treated with targeted temperature management (TTM) after cardiac arrest (CA).
  
  
  
  We conducted a retrospective single centre study of post cardiac arrest patients treated with TTM. ONSD and GWR on brain computed tomography (CT) was measured by two emergency physicians. We analysed the prognostic performance and cut offs of GWR and ONSD, singly and in combination in predicting poor neurologic outcome (CPC 3-5).
  
  
  
  Of the 119 patients studied, 74 patients showed poor outcome. The combination of ONSD and GWR significantly (p=0.002) improved prognostic performance (AUROC 0.67, 95% CI: 0.58-0.76, p<0.001) in predicting poor neurologic outcomes rather than each ONSD (AUROC 0.59, 95% CI: 0.50-0.68, p=0.08) or GWR (AUROC 0.65, 95% CI: 0.56-0.74, p=0.002) alone. A combined cut off of 'GWR and ONSD (1.16 and 4.9)' and 'GWR or ONSD (1.13 or 6.5)' improved the sensitivity for predicting poor outcome while maintaining high specificity compared to GWR alone.
  
  
  
  The combination of ONSD and GWR yielded improved prognostic value for predicting poor neurologic outcomes in post cardiac arrest patients treated with TTM.
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Minjung Kathy
authors.initials: MK
authors.lastname: Chae
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Eunsil
authors.initials: E
authors.lastname: Ko
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Tae Rim
authors.initials: TR
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hee
authors.initials: H
authors.lastname: Yoon
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Yeon
authors.initials: SY
authors.lastname: Hwang
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Won Chul
authors.initials: WC
authors.lastname: Cha
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Tae Gun
authors.initials: TG
authors.lastname: Shin
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: coldco2@naver.com.
authors.forename: Min Seob
authors.initials: MS
authors.lastname: Sim
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Ik Joon
authors.initials: IJ
authors.lastname: Jo
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Keun Jeong
authors.initials: KJ
authors.lastname: Song
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Joong Eui
authors.initials: JE
authors.lastname: Rhee
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Yeon Kwon
authors.initials: YK
authors.lastname: Jeong
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging* / Q000473:pathology; D006323:Heart Arrest / Q000150:complications / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009900:Optic Nerve / Q000000981:diagnostic imaging* / Q000473:pathology; D012372:ROC Curve; D015427:Reperfusion Injury / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D066127:White Matter / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: Brain computed tomography; Cardiac arrest; Grey-to-white matter ratio; Optic nerve sheath diameter; Targeted temperature management