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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis

J Dubourg, E Javouhey, T Geeraerts, M Messerer, and B Kassai.

Review published: 2011.

CRD summary

The review concluded that ultrasonography of optic nerve sheath diameter showed a good level of diagnostic accuracy for detecting intracranial hypertension in adult patients with traumatic brain injury and intracranial haemorrhage. The review was generally well conducted and the authors’ conclusions are based on the evidence and seem reasonable but the evidence base was small and lacked statistical power.

Authors' objectives

To evaluate the diagnostic accuracy of ultrasonography of optic nerve sheath diameter for the assessment of intracranial hypertension.

Searching

Four databases which included PubMed and EMBASE were searched from 1960 to July 2010 for articles in any language. Search terms were reported. Ongoing trials were searched for in ClinicalTrials.gov. Conference proceedings were searched from 2005 to 2009. Google Scholar was searched. Reference lists of identified studies were searched.

Study selection

Studies that assessed the diagnostic accuracy of ultrasonography of optic nerve sheath diameter versus intraventricular or intraparenchymal intracranial pressure monitoring for the assessment of intracranial hypertension were eligible for inclusion.

The included studies were prospective cross-sectional design. Studies were of adult patients (older than 18 years) with traumatic brain injury, subarachnoid haemorrhage, stroke, intracranial haemorrhage, intracranial haematoma, severe brain injury and spontaneous or primary intracerebral haemorrhage. Four studies used ultrasonography of optic nerve sheath diameter and intraventricular or intraparenchymal intracranial pressure monitoring simultaneously. Two studies had less than a one hour delay between the two tests. The threshold ranged from 5.0mm to 5.9mm. Studies were published between 2007 and 2009.

Three reviewers independently undertook study selection. Disagreements were resolved by consensus.

Assessment of study quality

Quality assessment was undertaken using the QUADAS Tool for independent blind comparison, appropriate patient population, sufficient description of intervention and short delay (less than one hour) between tests. Studies were scored as high quality (fulfilled all four criteria) or lower quality (did not fulfil all four criteria).

Three reviewers independently undertook quality assessment.

Data extraction

Data were extracted to populate 2x2 contingency tables used to calculate sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratios (0.5 added to zero values); 95% confidence intervals (CIs) were calculated using normal or Poisson approximations.

Three reviewers independently extracted data. Disagreements were resolved by consensus and discussion with the principle investigator.

Methods of synthesis

Bivariate random-effects meta-analysis was used to calculate pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratios, together with 95% CIs. Cochran Q and Ι² statistics were used to assess statistical heterogeneity. Summary receiver operating characteristic graphs were constructed and areas under the curves were calculated. Meta-regression was used to explore clinical heterogeneity using the restricted maximum-likelihood estimation. Publication bias was assessed using funnel plots and Egger’s test.

Results of the review

Six studies were included in the review (231 patients, range 15 to 63). All studies were deemed high quality. There was no evidence of publication bias.

Ultrasonography for detection of raised intracranial pressure was associated with a pooled sensitivity of 0.90 (95% CI 0.80 to 0.95; six studies), a pooled specificity of 0.85 (95% CI 0.73 to 0.93; six studies) and a pooled diagnostic odds ratio of 51 (95% CI 22 to 121). The area under the summary receiver-operating characteristic curve was 0.94 (95% CI 0.91 to 0.96). The pooled likelihood positive ratio was 6.11 (95% CI 3.28 to 11.37) and the negative ratio was 0.12 (95% CI 0.06 to 0.23). There was no evidence of significant statistical heterogeneity in any of the analyses.

Meta-regression did not show a significant association between study characteristics and diagnostic odds ratios.

Authors' conclusions

Ultrasonography of optic nerve sheath diameter showed a good level of diagnostic accuracy for detecting intracranial hypertension in adult patients with traumatic brain injury and intracranial haemorrhage.

CRD commentary

Inclusion criteria for the review were clearly defined. Several relevant databases were searched without language restrictions. Publication bias was assessed and not detected (the meaningfulness of an analysis with fewer than 10 studies was limited). Attempts were made to reduce reviewer error and bias throughout the review. Quality assessment indicated that the quality of the evidence base was generally good. There were differences across the trials in terms of intervention, patients and control.

Data were combined using suitable meta-analysis techniques and there was no evidence of significant statistical heterogeneity. There was reportedly no evidence of significant clinical or methodological heterogeneity in the meta-regression analysis.

The review was generally well conducted and the authors’ conclusions were based on the evidence and seem reasonable. The authors noted that the size of the evidence base was small and that results lacked statistical power; this should be considered when interpreting the review.

Implications of the review for practice and research

Practice: The authors stated that ultrasonography of optic nerve sheath diameter may help physicians decide to transfer patients to specialised centres or to place an invasive device where no specific recommendations exist.

Research: The authors stated that the application of ultrasonography of optic nerve sheath diameter in other clinical situations with intracranial hypertension (such as meningitis, severe encephalitis or valve dysfunction) required further study.

Funding

Not stated.

Bibliographic details

Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Medicine 2011; 37(7): 1059-1068. [PubMed: 21505900]

PubMedID

21505900

Indexing Status

Subject indexing assigned by NLM

MeSH

Humans; Intracranial Hypertension /physiopathology /ultrasonography; Intracranial Pressure /physiology; Myelin Sheath /ultrasonography; Optic Nerve /physiopathology /ultrasonography

AccessionNumber

12012035011

Date bibliographic record published

31/10/2012

Date abstract record published

24/01/2013

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 21505900

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