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Crit Care Res Pract. 2018 Apr 30;2018:3589762. doi: 10.1155/2018/3589762. eCollection 2018.

New Optic Nerve Sonography Quality Criteria in the Diagnostic Evaluation of Traumatic Brain Injury.

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Neurocritical Care Unit, Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.
Undergraduate Medical Education, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Department of Surgery, Rady Faculty of Health Science, University of Manitoba, Winnipeg, MB, Canada.
Clinician Investigator Program, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Division of Anesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Division of Neurocritical Care, Departments of Neurology and Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
Department of Critical Care, Keck Medical School, USC, Los Angeles, CA, USA.



New sonographic quality criteria to optimize optic nerve sheath diameter (ONSD) measurements were suggested. The latter were correlated to elevated intracranial pressure (ICP) in traumatic brain injury (TBI).


We investigated whether ONSD measurements were correlated to simultaneous ICP measurements in severe TBI.


Forty patients with severe TBI (Marshall Scale ≥II and GCS ≤8) participated in the study. All patients had an intraparenchymal ICP catheter inserted, while ONSD was measured bilaterally, upon admission and over the next 48 hours, based on the new sonographic criteria. A total of 400 ONSD measurements were performed, while mean ONSD values of both eyes were used in the analysis.


ONSD measurements were strongly correlated to ICP values (r=0.74, p < 0.0001). Receiver operator curve (ROC) analysis revealed that the ONSD cutoff value for predicting elevated ICP was 6.4 mm when using the mean of both eyes (AUC = 0.88, 95% CI = 0.80 to 0.95; sensitivity = 85.3%, specificity = 82.6%). Linear regression analysis nested models revealed that sex (p=0.006) and height (p=0.04) were significant predictors of ONSD values.


When applying the new sonographic quality criteria, ONSD is strongly correlated to ICP in severe TBI. Whether to use such criteria to monitor ONSD as a proxy for ICP trend in TBI remains to be further explored.

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