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Estimation of optic nerve sheath diameter on an initial brain computed tomography scan can contribute prognostic information in traumatic brain injury patients.

Legrand A, Jeanjean P, Delanghe F, Peltier J, Lecat B, Dupont H - Crit Care (2013)

Bottom Line: Demographic and clinical data and brain CT scan results were recorded.The group of ICU survivors was compared to non-survivors.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).

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ABSTRACT

Introduction: 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.

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Optic nerve sheath diameter measurement on the initial brain computed tomography scan (using DxMM™ software).
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Figure 1: Optic nerve sheath diameter measurement on the initial brain computed tomography scan (using DxMM™ software).

Mentions: The same physician (AL) examined all initial CT scans included in the study. He was blinded to the patient's medical history, the circumstances of the TBI and the patient's severity scores at the time of measurement. All CTs were performed before surgery, when needed. ONSD was measured on the first brain CT scan recorded prior to the patient's admission to the ICU. Brain CT scan was performed with a series of millimetre slices (one slice every 0.6 mm). As for ultrasound or magnetic resonance imaging (MRI), ONSD was measured at a distance of 3 mm behind the eyeball, immediately below the sclera [17,18] using DxMM software (DICOM v6.5 SP5, Medasys™, Gif-sur-Yvette, France). ONSD was measured from one side of the optic nerve sheath to the other (as shown in Figure 1) as a section through the centre of the optic nerve. The diameters measured for the patient's left and right eyes were averaged to yield the mean value. Before starting the study, intra- and inter-observer variabilities were evaluated on three different physicians and were calculated retrospectively by analysis of brain CT scans. Intra-observer variability of ONSD measurement was 2% ± 2% (Cronbach's α coefficient = 0.996) and inter-observer variability was 6% ± 5% (Cronbach's α coefficient = 0.893).


Estimation of optic nerve sheath diameter on an initial brain computed tomography scan can contribute prognostic information in traumatic brain injury patients.

Legrand A, Jeanjean P, Delanghe F, Peltier J, Lecat B, Dupont H - Crit Care (2013)

Optic nerve sheath diameter measurement on the initial brain computed tomography scan (using DxMM™ software).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672708&req=5

Figure 1: Optic nerve sheath diameter measurement on the initial brain computed tomography scan (using DxMM™ software).
Mentions: The same physician (AL) examined all initial CT scans included in the study. He was blinded to the patient's medical history, the circumstances of the TBI and the patient's severity scores at the time of measurement. All CTs were performed before surgery, when needed. ONSD was measured on the first brain CT scan recorded prior to the patient's admission to the ICU. Brain CT scan was performed with a series of millimetre slices (one slice every 0.6 mm). As for ultrasound or magnetic resonance imaging (MRI), ONSD was measured at a distance of 3 mm behind the eyeball, immediately below the sclera [17,18] using DxMM software (DICOM v6.5 SP5, Medasys™, Gif-sur-Yvette, France). ONSD was measured from one side of the optic nerve sheath to the other (as shown in Figure 1) as a section through the centre of the optic nerve. The diameters measured for the patient's left and right eyes were averaged to yield the mean value. Before starting the study, intra- and inter-observer variabilities were evaluated on three different physicians and were calculated retrospectively by analysis of brain CT scans. Intra-observer variability of ONSD measurement was 2% ± 2% (Cronbach's α coefficient = 0.996) and inter-observer variability was 6% ± 5% (Cronbach's α coefficient = 0.893).

Bottom Line: Demographic and clinical data and brain CT scan results were recorded.The group of ICU survivors was compared to non-survivors.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).

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: 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.

Show MeSH
Related in: MedlinePlus