Optic Nerve Sheath Diameter Cutoff Point for Detection of Increased Intracranial Pressure in the Emergency Department

Wanatchaporn  Ussahgij; Wipada  Toonpirom; Waranon  Munkong; Kamonwon  Lenghong; Korakot Apiratwarakul

doi:10.3889/oamjms.2020.3272

Authors

Wanatchaporn Ussahgij Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Wipada Toonpirom Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Waranon Munkong Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Kamonwon Lenghong Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Korakot Apiratwarakul Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

DOI:

https://doi.org/10.3889/oamjms.2020.3272

Keywords:

Optic Nerve Sheath Diameter, Increased Intracranial Pressure, Ultrasound, Emergency department, Emergency medicine

Abstract

BACKGROUND: Ultrasound of the optic nerve sheath diameter (ONSD) is one of the most widely used noninvasive methods of screening for high intracranial pressure.

AIM: This study aimed to measure the ONSD and to find the appropriate cutoff point to indicate increased intracranial pressure.

METHODS: We examined 93 participants over 18 years of age with abnormal neurologic signs or symptoms and took computerized tomography (CT) scans of their brains. We measured the ONSD through ultrasound with the head positioned at 30Â°. We also used a linear array probe to measure the ONSD in the position after connecting the eyeball 3 mm.

RESULTS: The average of the ONSD at each side was 4.76 mm (95% confidence interval [CI]: 4.65â€“4.87) in the normal CT scan group and 5.33 mm (95% CI: 5.13â€“5.33) in the abnormal CT scan (indicating high intracranial pressure) group. An ONSD cutoff point of 5.0 mm yielded 74.14% sensitivity and 49.22% specificity. The positive predictive value was 0.38 and negative predictive value was 0.82.

CONCLUSION: The ONSD in the abnormal CT scan group was greater than in the normal CT scan group, and an ONSD of 5.0 mm can be used as a cutoff point for detecting increased intracranial pressure.

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Author Biographies

Wipada Toonpirom, Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Waranon Munkong, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

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