Optic nerve sheath diameter sonography for the diagnosis of increased intracranial pressure: a systematic review and meta-analysis protocol

IntroductionIncreased intracranial pressure (ICP) is a significant neurological issue that may lead to permanent neurological sequelae. When evaluating patients with traumatic brain injury, it is crucial to identify those with high ICP in order to expedite ICP lowering measures and maintain adequate cerebral perfusion. Several measures are used to recognise patients with increased ICP including CT scan, MRI, ICP monitor, and lumbar puncture (LP). However, these tests can be invasive, associated with radiation exposure, contraindicated, or not readily available. Ultrasonography measurement of the optic nerve sheath diameter (ONSD) is proposed as a non-invasive and quick measure to identify high ICP. The aim of this systematic review and meta-analysis will be to examine the accuracy of ONSD sonography for increased ICP diagnosis.Methods and analysesWe will include published and unpublished randomised controlled trials, observational studies, and abstracts, with no publication type or language restrictions. Search strategies will be designed to peruse the MEDLINE, Embase, Web of Science, WHO Clinical Trials, ClinicalTrials.gov, CINAHL, and the Cochrane Library databases. We will also implement strategies to search grey literature. Two reviewers will independently complete data abstraction and conduct quality assessment. Included studies will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We will construct the hierarchical summary receiver operating characteristic curve for included studies and pool sensitivity and specificity using the bivariate model. We also plan to conduct prespecified subgroup analyses to explore heterogeneity. The overall quality of evidence will be rated using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).Ethics and disseminationResearch ethics board approval is not required for this study as it draws from published data and raises no concerns related to patient privacy. This review will provide a comprehensive assessment of the evidence on ONSD sonography diagnostic accuracy and is directed to a wide audience. Results from the review will be disseminated extensively through conferences and submitted to a peer-reviewed journal for publication.PROSPERO registration numberCRD42017055485.Clinical trial numberTrial registration number isNCT00783809.

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Ultrasonographic optic nerve sheath diameter to detect increased intracranial pressure in adults: a meta-analysis

Acta Radiologica ◽

10.1177/0284185118776501 ◽

2018 ◽

Vol 60 (2) ◽

pp. 221-229 ◽

Cited By ~ 10

Author(s):

Sung-Eun Kim ◽

Eun Pyo Hong ◽

Heung Cheol Kim ◽

Si Un Lee ◽

Jin Pyeong Jeon

Keyword(s):

Optic Nerve ◽

Intracranial Pressure ◽

Meta Analysis ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Increased Intracranial Pressure ◽

Summary Receiver Operating Characteristic ◽

Nerve Sheath ◽

Study Characteristics ◽

Meta Regression

Background The optimal optic nerve sheath diameter (ONSD) cut-off for identifying increased intracranial pressure (IICP) remains unclear in adult patients. Purpose To validate the diagnostic accuracy of ultrasonographic (US) ONSD > 5.0 mm as a cut-off for detecting IICP by computed tomographic (CT) through a meta-analysis. Material and Methods A systemic literature review was performed of online databases from January 1990 to September 2017. A bivariate random-effects model was used to estimate pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence intervals (CIs). A summary receiver operating characteristic (SROC) graph was used to provide summary points for sensitivity and specificity. Meta-regression tests were performed to estimate the influence of the study characteristics on DOR. Publication bias was assessed using Deeks' funnel plot asymmetry test. Results Six studies with 352 patients were included in the meta-analysis. US ONSD > 5.0 mm revealed pooled sensitivity of 99% (95% CI = 96–100) and specificity of 73% (95% CI = 65–80) for IICP detection. DOR was 178. The area under the SROC curve was 0.981, indicating a good level of accuracy. Meta-regression studies showed no significant associations between DOR and study characteristics such as probe mode (relative DOR [RDOR] = 0.60; P = 0.78), study quality (RDOR = 0.52; P = 0.67), IICP prevalence (RDOR = 0.04; P = 0.17), or pathology at admission (RDOR = 1.30; P = 0.87). Conclusion US ONSD > 5.0 mm can be used to rapidly detect IICP in adults in emergency departments and intensive care units. Further meta-analysis based on individual patient-level databases is needed to confirm these results.

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Ultrasonographic optic nerve sheath diameter for predicting elevated intracranial pressure during laparoscopic surgeries: a systematic review and meta-analysis

10.26226/morressier.58f5b033ab9a5f002a4c9bd0 ◽

2017 ◽

Author(s):

Jae Hee Seo

Keyword(s):

Systematic Review ◽

Optic Nerve ◽

Intracranial Pressure ◽

Meta Analysis ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Elevated Intracranial Pressure ◽

Nerve Sheath

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Faculty Opinions recommendation of Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733657659.793549501 ◽

2018 ◽

Author(s):

Masao Nagayama

Keyword(s):

Systematic Review ◽

Optic Nerve ◽

Intracranial Pressure ◽

Meta Analysis ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Non Invasive ◽

Nerve Sheath

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Ultrasonographic optic nerve sheath diameter for predicting elevated intracranial pressure during laparoscopic surgery: a systematic review and meta-analysis

Surgical Endoscopy ◽

10.1007/s00464-017-5653-3 ◽

2017 ◽

Vol 32 (1) ◽

pp. 175-182 ◽

Cited By ~ 5

Author(s):

Eun Jung Kim ◽

Bon-Nyeo Koo ◽

Seung Ho Choi ◽

Kyoungun Park ◽

Min-Soo Kim

Keyword(s):

Systematic Review ◽

Laparoscopic Surgery ◽

Optic Nerve ◽

Intracranial Pressure ◽

Meta Analysis ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Elevated Intracranial Pressure ◽

Nerve Sheath

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Evaluation of the Relationship Between NIRS (Near-Infrared Spectroscopy) and Optic Nerve Sheath Diameter Measurement in Children with Increased Intracranial Pressure: A Pilot Study

10.21203/rs.3.rs-95069/v1 ◽

2020 ◽

Author(s):

Didar Arslan ◽

Dinçer Yildizdas ◽

Özden ÖZGÜR HOROZ ◽

Nagehan Aslan ◽

Faruk İNCECİK

Keyword(s):

Infrared Spectroscopy ◽

Optic Nerve ◽

Intracranial Pressure ◽

Near Infrared ◽

Optic Nerve Sheath Diameter ◽

Increased Intracranial Pressure ◽

Mean Values ◽

Nerve Sheath ◽

The Mean ◽

Increased Icp

Abstract Background: The increased intracranial pressure (ICP) syndrome may emerge depending on many different neurological factors and the early diagnosis and treatment are important for the prevention of neurologic damage and related mortality. In recent years, the follow-up of increased ICP with non-invasive methods has been increasing. In this study, our objective was to determine the significance of ONSD (Optic Nerve Sheath Diameter) and NIRS (Near-Infrared Spectroscopy) in children with increased ICP and any possible correlation between ONSD and NIRS. Methods: Patients who were hospitalized in our pediatric ICU at Çukurova University Medical Faculty between June 2018 and June 2019 due to the suspicion of increased ICP were included in this study. The demographic characteristics of patients, diagnosis at admission, results of the cranial CT and MRI examinations, and results of the simultaneous ONSD and NIRS measurements were recorded. Results: A total of 36 patients were included in our study. With respect to the diagnosis, non-traumatic causes were at the forefront in 30 patients (83.3%), and the most common causes were meningoencephalitis (n=9; 25%) and non-traumatic bleeding (n=7; 19.4%). Six of the patients were under the age of one year (16.7%), and the mean values of ONSD and NIRS were 4.8±0.7 mm and 71.1±12.4% respectively in this group. Fourteen patients were in the one to ten year age group and the mean values of ONSD and NIRS were 6.1±0.6 mm and 72.7±9.3% respectively. Sixteen patients were over ten years of age (44.4%), and the mean values of ONSD and NIRS were 5.6±0.7 mm and 74.2±16% respectively. There was no correlation between the ONSD and NIRS values (r:0.3; p=0.07).Conclusion: Our study showed that ONSD measurements were helpful in children with increased ICP and reflected the increase in ICP. However, our study also demonstrated that ONSD was not in correlation with the NIRS monitoring. We believe that there is a need for further studies focused on the use of ONSD and NIRS in the monitoring of increased ICP.

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Evaluation of the relationship between NIRS (near-infrared spectroscopy) and optic nerve sheath diameter measurement in children with increased intracranial pressure: a pilot study

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01035-2 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Didar Arslan ◽

Dinçer Yıldızdaş ◽

Özden Özgür Horoz ◽

Nagehan Aslan ◽

Faruk İncecik

Keyword(s):

Infrared Spectroscopy ◽

Optic Nerve ◽

Intracranial Pressure ◽

Near Infrared ◽

Optic Nerve Sheath Diameter ◽

Increased Intracranial Pressure ◽

Mean Values ◽

Nerve Sheath ◽

The Mean ◽

Increased Icp

Abstract Background The increased intracranial pressure (ICP) syndrome may emerge depending on many different neurological factors and the early diagnosis and treatment are important for the prevention of neurologic damage and related mortality. In recent years, the follow-up of increased ICP with non-invasive methods has been rising. In this study, our objective was to determine the significance and any possible correlation between Optic Nerve Sheath Diameter (ONSD) and Near Infrared Spectroscopy (NIRS) in children with increased ICP. Methods Patients who were hospitalized in our pediatric ICU at Çukurova University Medical Faculty between June 2018 and June 2019 due to the suspicion of increased ICP were included in this study. The demographic characteristics of patients, diagnosis at admission, results of the cranial CT and MRI examinations, and results of the simultaneous ONSD and NIRS measurements were recorded. Results A total of 36 patients were included in our study. With respect to the diagnosis, non-traumatic causes were at the forefront in 30 patients (83.3%), and the most common causes were meningoencephalitis (n = 9; 25%) and non-traumatic bleeding (n = 7; 19.4%). Six of the patients were under the age of one year (16.7%), and the mean values of ONSD and NIRS were 4.8 ± 0.7 mm and 71.1 ± 12.4% respectively in this group. Fourteen patients were in the one to ten year age group and the mean values of ONSD and NIRS were 6.1 ± 0.6 mm and 72.7 ± 9.3% respectively. Sixteen patients were over ten years of age (44.4%), and the mean values of ONSD and NIRS were 5.6 ± 0.7 mm and 74.2 ± 16% respectively. There was no correlation between the ONSD and NIRS values (r:0.307; p = 0.068). Conclusion Our study showed that ONSD measurements were helpful in children with increased ICP and reflected the increase in ICP. However, our study also demonstrated that ONSD was not in correlation with the NIRS monitoring. We believe that there is a need for further studies focused on the use of ONSD and NIRS in the monitoring of increased ICP.

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