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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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Box plot of optic nerve sheath diameter (mm) according to the Glasgow Outcome Scale (GOS) determined six months after discharge from ICU for 55 survivors (P = 0.03).
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Figure 4: Box plot of optic nerve sheath diameter (mm) according to the Glasgow Outcome Scale (GOS) determined six months after discharge from ICU for 55 survivors (P = 0.03).

Mentions: The GOS six months after discharge for the 55 ICU survivors was as follows: GOS 1 (n = 5, 9.1%), GOS 2 (n = 2, 3.6%), GOS 3 (17, 30.1%), GOS 4 (n = 13, 23.6%) and GOS 5 (n = 18, 32.7%). Overall six-month mortality in severe TBI was 35%. A statistically significant relationship was observed between GOS and initial ONSD measurement, as shown in Figure 4 (P = 0.03).


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)

Box plot of optic nerve sheath diameter (mm) according to the Glasgow Outcome Scale (GOS) determined six months after discharge from ICU for 55 survivors (P = 0.03).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Box plot of optic nerve sheath diameter (mm) according to the Glasgow Outcome Scale (GOS) determined six months after discharge from ICU for 55 survivors (P = 0.03).
Mentions: The GOS six months after discharge for the 55 ICU survivors was as follows: GOS 1 (n = 5, 9.1%), GOS 2 (n = 2, 3.6%), GOS 3 (17, 30.1%), GOS 4 (n = 13, 23.6%) and GOS 5 (n = 18, 32.7%). Overall six-month mortality in severe TBI was 35%. A statistically significant relationship was observed between GOS and initial ONSD measurement, as shown in Figure 4 (P = 0.03).

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