Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Availability of the Optic Nerve Sheath Diameter Measured by Using Ultrasonography as a Secondary Survey for Patient with Head Injuries in the Emergency Department

응급실에 내원한 두부외상환자의 2차 평가로써 초음파를 이용한 시각신경집 지름 측정은 유용한가?

  • Lee, Dong Wook (Department of Emergency Medicine, Soon Chun Hyang University College of Medicine) ;
  • Lee, Jung Won (Department of Emergency Medicine, Soon Chun Hyang University College of Medicine) ;
  • Park, Sae Hoon (Department of Emergency Medicine, Soon Chun Hyang University College of Medicine) ;
  • Park, Ihl Sung (Department of Emergency Medicine, Soon Chun Hyang University College of Medicine) ;
  • Lee, Hyun Jung (Department of Emergency Medicine, Soon Chun Hyang University College of Medicine) ;
  • Yoo, Byeong Dae (Department of Emergency Medicine, Soon Chun Hyang University College of Medicine) ;
  • Moon, Hyung Jun (Department of Emergency Medicine, Soon Chun Hyang University College of Medicine)
  • 이동욱 (순천향대학교 천안병원 응급의학교실) ;
  • 이정원 (순천향대학교 천안병원 응급의학교실) ;
  • 박세훈 (순천향대학교 천안병원 응급의학교실) ;
  • 박일성 (순천향대학교 천안병원 응급의학교실) ;
  • 이현정 (순천향대학교 천안병원 응급의학교실) ;
  • 유병대 (순천향대학교 구미병원 응급의학교실) ;
  • 문형준 (순천향대학교 천안병원 응급의학교실)
  • Received : 2013.07.19
  • Accepted : 2013.08.28
  • Published : 2013.09.30
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Abstract

Purpose: Bedside ultrasonography is available in most emergency departments, and detecting the intracranial pressure is elevated is critical. Our objective is to evaluate the availability of bedside optic nerve ultrasound (ONUS) as a secondary survey for patients with head injuries in the emergency department (ED). Methods: From September, 2012, to March, 2013, we performed a prospective study of patients presenting to the ED after an accident. Patients with head injuries but without obvious ocular trauma or ocular disease were included. The ONUS was performed using a 3 to 12 MHz linear probe on closed eyelids after a primary survey. We analyzed the correlation between the brain computed tomography (CT) findings that suggested elevated intracranial pressure (ICP) and the Optic nerve sheath diameter (ONSD) measured by using ONUS. Results: A total of 81 patients were enrolled. Forty-seven had CT results consistent with elevated ICP, and their mean ONSD was $5.98{\pm}0.59$ mm; the mean ONSD of patients who showed no signs of elevated ICP on CT was $4.63{\pm}0.21$ mm. The sensitivity and the specificity for the ONSD, compared with elevated ICP, were 98.87% and 100%, respectively, when the cut-off value was set to 4.96 mm. The area under curve (AUC) was 0.997 in the receiver operating characteristic curve (ROC curve). Conclusion: An evaluation using ONUS is a simple noninvasive procedure and is a potentially useful tool as a secondary survey to identify an elevated ICP.

Keywords

References

  1. Münch EC, Bauhuf C, Horn P, Roth HR, Schmiedek P, Vajkoczy P. Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage. Critical care medicine 2001; 29: 976-81. https://doi.org/10.1097/00003246-200105000-00016
  2. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Initial management. Journal of neurotrauma2000. p. 463-9.
  3. Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency Department Sonographic Measurement of Optic Nerve Sheath Diameter to Detect Findings of Increased Intracranial Pressure in Adult Head Injury Patients. Annals of Emergency Medicine 2007; 49: 508-14. https://doi.org/10.1016/j.annemergmed.2006.06.040
  4. Eisenberg HM, Gary HE, Jr., Aldrich EF, Saydjari C, Turner B, Foulkes MA, et al. Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. Journal of neurosurgery 1990; 73: 688-98. https://doi.org/10.3171/jns.1990.73.5.0688
  5. Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. Journal of neurosurgery 1997; 87: 34-40. https://doi.org/10.3171/jns.1997.87.1.0034
  6. Hong DY, Kim KH, Lee KM, Kim JH, Kim JS, Han SB, et al. Increased Intracranial Pressure Detected by Emergency Ultrasonography of the Optic Nerve Sheath Diameter. Korean Soc Emerg Med 2006; 17: 238-44.
  7. Goel RS, Goyal NK, Dharap SB, Kumar M, Gore MA. Utility of optic nerve ultrasonography in head injury. Injury 2008; 39: 519-24. https://doi.org/10.1016/j.injury.2007.09.029
  8. Liu D, Kahn M. Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers. American journal of ophthalmology 1993; 116: 548-56. https://doi.org/10.1016/S0002-9394(14)73195-2
  9. Hayreh SS. Pathogenesis of oedema of the optic disc. Documenta ophthalmologica Advances in ophthalmology 1968; 24: 289-411. https://doi.org/10.1007/BF02550944
  10. Hansen LF, Nielsen GD. Sensory irritation and pulmonary irritation of n-methyl ketones: receptor activation mechanisms and relationships with threshold limit values. Archives of toxicology 1994; 68: 193-202. https://doi.org/10.1007/s002040050054
  11. Romagnuolo L, Tayal V, Tomaszewski C, Saunders T, Norton HJ. Optic nerve sheath diameter does not change with patient position. The American journal of emergency medicine 2005; 23: 686-8. https://doi.org/10.1016/j.ajem.2004.11.004
  12. Blaivas M, Theodoro D, Sierzenski PR. A study of bedside ocular ultrasonography in the emergency department. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine 2002; 9: 791-9. https://doi.org/10.1111/j.1553-2712.2002.tb02166.x
  13. Ballantyne J, Hollman AS, Hamilton R, Bradnam MS, Carachi R, Young DG, et al. Transorbital optic nerve sheath ultrasonography in normal children. Clinical radiology 1999; 54: 740-2. https://doi.org/10.1016/S0009-9260(99)91176-5
  14. Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine 2003; 10: 376-81. https://doi.org/10.1111/j.1553-2712.2003.tb01352.x
  15. Oh SK, Cho YC, Koo DH, Ryu S, Lee JW, Kim SW, et al. Utility of Optic Nerve Sheath Diameter Measured by Ultrasonography for the Detection of Increased Intracranial Pressure in Adults. Korean Soc Emerg Med 2008; 19: 708-14.
  16. Ballantyne SA, O'Neill G, Hamilton R, Hollman AS. Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. European journal of ultrasound : official journal of the European Federation of Societies for Ultrasound in Medicine and Biology 2002; 15: 145-9.