Evaluation of optic nerve sheath diameter in the management of patients with traumatic brain injury in emergency department
Abstract
Aim: In the literature ultrasonographic optic nerve sheath diameter measurement are associated with elevated intracranial pressure. Patients with intracranial pressure measurements are critical or intensive care patients. There is no study on the effect of optic nerve sheath diameter predicting pathology or surgery. Our study aimed to compare the optic nerve sheath diameter of the patients presenting with head trauma with cranial tomography findings and clinical outcomes.
Materials and Methods: In the prospective cross-sectional study, head trauma patients admitted to the emergency department were evaluated as mild, moderate, and severe brain injuries. We
measured optic nerve sheath diameters by ultrasonography. Findings were compared with patients' outcomes and cranial tomography characteristics.
Results: The most common mild traumatic brain injury was found in examining 58 patients in the study. Hospitalization or surgery was required in 51.7% (30) of the patients. The mean optic nerve sheath diameter measurements were 4.96±1.02 mm (3.1-7.3) on the right and 4.92±1.02 mm (3.3-7.8) on the left. Detection of optic nerve sheath diameter values of 5 mm and above was found statisticallysignificant in predicting hospitalization (p<0.05). In predicting the presence of pathology and elevated intracranial pressure in cranial tomography, an optic nerve sheath diameter value above 5 mm was found statistically significant (p<0.05).
Conclusions: The optic nerve sheath diameter measurement can provide information about the patient's hospitalization or operation needs. It can use as a triage criterion in need of monitored followup and imaging priorities at the mild and moderate head trauma presenting to the emergency department.
References
- Moppett IK. Traumatic brain injury: Assessment, resuscitation and early management. Br J Anaesth Br J Anaesth. 2007; 99(1):18-31. doi:10.1093/bja/aem128.
- Helmy A, Vizcaychipi M, Gupta AK. Traumatic brain injury: intensive care management. Br J Anaesth. 2007; 99(1):32-42. doi:10.1093/bja/aem139.
- Jimenez Restrepo JN, León OJ, Quevedo Florez LA. Ocular Ultrasonography: A Useful Instrument in Patients with Trauma Brain Injury in Emergency Service. Emerg Med Int. 2019;2019:1-6. doi:10.1155/2019/9215853.
- Rosenfeld JV., Maas AI, Bragge P, Morganti-Kossmann MC, Manley GT, Gruen RL. Early management of severe traumatic brain injury. Lancet. 2012;380(9847):1088-98. doi:10.1016/S0140-6736(12)60864-2.
- Martin M, Lobo D, Bitot V, et al. Prediction of Early Intracranial Hypertension After Severe Traumatic Brain Injury: A Prospective Study. World Neurosurg. 2019;127:e1242-48. doi:10.1016/j.wneu.2019.04.121.
- Geeraerts T, Launey Y, Martin L, et al. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med. 2007;33(10):1704-11. doi:10.1007/ s00134-007-0797-6.
- Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med. 2003;10(4):376-81. doi:10.1197/aemj.10.4.376.
- 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. Ann Emerg Med. 2007;49(4):508-14. doi:10.1016/j.annemergmed.2006.06.040
- Seabury SA, Gaudette É, Goldman DP, et al. Assessment of Follow-up Care After Emergency Department Presentation for Mild Traumatic Brain Injury and Concussion: Results From the TRACK-TBI Study. JAMA Netw open. 2018;1(1):e180210. doi:10.1001/jamanetworkopen.2018.0210.
- Altayar AS, Abouelela AZ, Abdelshafey EE, et al. Optic nerve sheath diameter by ultrasound is a good screening tool for high intracranial pressure in traumatic brain injury. Ir J Med Sci. 2021;190(1):387-93. doi:10.1007/s11845-020-02242-2.
- Robba C, Santori G, Czosnyka M, et al. Optic nerve sheath diameter measured sonographically as noninvasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2018;44(8):1284-94. doi:10.1007/s00134-018-5305-7.
- Soldatos T, Chatzimichail K, Papathanasiou M, Gouliamos A. Optic nerve sonography: A new window for the non-invasive evaluation of intracranial pressure in brain injury. Emerg Med J. 2009;26(9):630-34. doi:10.1136/emj.2008.058453.
- Amini A, Kariman H, Arhami Dolatabadi A, et al. Use of the sonographic diameter of optic nerve sheath to estimate intracranial pressure. Am J Emerg Med. 2013;31(1):236-39. doi:10.1016/j.ajem.2012.06.025.
- Major R, Girling S, Boyle A. Ultrasound measurement of optic nerve sheath diameter in patients with a clinical suspicion of raised intracranial pressure. Emerg Med J. 2011;28(8):679-81. doi:10.1136/ emj.2009.087353.
- Roque PJ, Wu TS, Barth L, et al. Optic nerve ultrasound for the detection of elevated intracranial pressure in the hypertensive patient. Am J Emerg Med. 2012;30(8):1357-63. doi: 10.1016/j.ajem.2011.09.025. Epub 2011 Dec 26. PMID: 22204998.
- Das SK, Shetty SP, Sen KK. A novel triage tool: Optic nerve sheath diameter in traumatic brain injury and its correlation to rotterdam computed tomography (CT) scoring. Polish J Radiol. 2017;82:240-43. doi:10.12659/PJR.900196.
- Raffiz M, Abdullah JM. Optic nerve sheath diameter measurement: a means of detecting raised ICP in adult traumatic and non-traumatic neurosurgical patients. Am J Emerg Med. 2017;35(1):150-53. doi:10.1016/ j.ajem.2016.09.044.
- Jeon JP, Lee SU, Kim SE, et al. Correlation of optic nerve sheath diameter with directly measured intracranial pressure in Korean adults using bedside ultrasonography. PLoS One. 2017;12(9):1-11. doi:10.1371/journal.pone.0183170.
Acil servise kafa travması ile başvuran hastaların yönetiminde optik sinir kılıf çapı ölçümünün değerlendirilmesi
Abstract
Amaç: Literatürde ultrasonografik olarak optik sinir kılıf çapı ölçümünde saptanan değerler, kafa içi basınç artışı ile ilişkilendirilmektedir. Kafa içi basıncı ölçümü yapılan hastalar kritik alan ya da yoğun bakım hastalarıdır. Hafif ya da orta şiddette kafa travmasında patolojiyi ya da operasyona gidişi öngörmede ultrasonografi ile optik sinir kılıf çapı ölçümünün etkisi değerlendirilmemiştir. Çalışmamızda kafa travması ile başvuran hastaların, ultrasonografi ile optik sinir kılıf çapı ölçüm değerlerini, kraniyal tomografi bulguları ve hastaların klinik sonlanımları ile karşılaştırmayı hedefledik.
Gereç ve Yöntem: Prospektif kesitsel planlanan çalışmada acil servise başvuran kafa travmalı hastalar hafif, orta ve şiddetli beyin hasarı olarak değerlendirildi. Çalışmaya dahil edilen hastaların
ultrasonografi ile optik sinir kılıf çapları ölçüldü. Bulgular hastaların sonlanımları ve kraniyal tomografi özellikleri ile karşılaştırıldı.
Bulgular: Acil servise kafa travması ile başvuran 58 hastanın incelemesinde en sık hafif şiddette travmatik beyin hasarına rastlandı. Hastaların %51,7 (30)’sinde yatış ya da operasyon ihtiyacı vardı.
Optik sinir kılıf çapı ölçümlerinin ortalaması sağda 4,96±1,02 mm (3,1-7,3) solda ise 4,92±1,02 mm (3,3-7,8) olarak bulunmuştur. Optik sinir kılıf çapı ölçüm değerlerinin 5 mm ve üzerinde saptanması
hastaneye yatışı öngörmede istatistiksel olarak anlamlı olarak saptandı (p<0,05). Kraniyal tomografide patoloji varlığını ve kafa içi basınç artışını öngörmede optik sinir kılıf çapı ölçüm değerinin 5 mm üzerinde olması istatistiksel olarak anlamlı saptandı (p<0,05).
Sonuç: Kafa travması ile acil servise başvuran orta ve hafif kafa travması sınıfında da optik sinir kılıf çapı ölçüm değerleri, hastanın yatış ya da operasyon ihtiyacı hakkında bilgi verebilir, hastaların acil serviste monitörize izlem ihtiyacının belirlenmesi, görüntüleme önceliklerinin saptanmasında bir triaj kriteri olarak kullanılabilir.
References
- Moppett IK. Traumatic brain injury: Assessment, resuscitation and early management. Br J Anaesth Br J Anaesth. 2007; 99(1):18-31. doi:10.1093/bja/aem128.
- Helmy A, Vizcaychipi M, Gupta AK. Traumatic brain injury: intensive care management. Br J Anaesth. 2007; 99(1):32-42. doi:10.1093/bja/aem139.
- Jimenez Restrepo JN, León OJ, Quevedo Florez LA. Ocular Ultrasonography: A Useful Instrument in Patients with Trauma Brain Injury in Emergency Service. Emerg Med Int. 2019;2019:1-6. doi:10.1155/2019/9215853.
- Rosenfeld JV., Maas AI, Bragge P, Morganti-Kossmann MC, Manley GT, Gruen RL. Early management of severe traumatic brain injury. Lancet. 2012;380(9847):1088-98. doi:10.1016/S0140-6736(12)60864-2.
- Martin M, Lobo D, Bitot V, et al. Prediction of Early Intracranial Hypertension After Severe Traumatic Brain Injury: A Prospective Study. World Neurosurg. 2019;127:e1242-48. doi:10.1016/j.wneu.2019.04.121.
- Geeraerts T, Launey Y, Martin L, et al. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med. 2007;33(10):1704-11. doi:10.1007/ s00134-007-0797-6.
- Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med. 2003;10(4):376-81. doi:10.1197/aemj.10.4.376.
- 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. Ann Emerg Med. 2007;49(4):508-14. doi:10.1016/j.annemergmed.2006.06.040
- Seabury SA, Gaudette É, Goldman DP, et al. Assessment of Follow-up Care After Emergency Department Presentation for Mild Traumatic Brain Injury and Concussion: Results From the TRACK-TBI Study. JAMA Netw open. 2018;1(1):e180210. doi:10.1001/jamanetworkopen.2018.0210.
- Altayar AS, Abouelela AZ, Abdelshafey EE, et al. Optic nerve sheath diameter by ultrasound is a good screening tool for high intracranial pressure in traumatic brain injury. Ir J Med Sci. 2021;190(1):387-93. doi:10.1007/s11845-020-02242-2.
- Robba C, Santori G, Czosnyka M, et al. Optic nerve sheath diameter measured sonographically as noninvasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2018;44(8):1284-94. doi:10.1007/s00134-018-5305-7.
- Soldatos T, Chatzimichail K, Papathanasiou M, Gouliamos A. Optic nerve sonography: A new window for the non-invasive evaluation of intracranial pressure in brain injury. Emerg Med J. 2009;26(9):630-34. doi:10.1136/emj.2008.058453.
- Amini A, Kariman H, Arhami Dolatabadi A, et al. Use of the sonographic diameter of optic nerve sheath to estimate intracranial pressure. Am J Emerg Med. 2013;31(1):236-39. doi:10.1016/j.ajem.2012.06.025.
- Major R, Girling S, Boyle A. Ultrasound measurement of optic nerve sheath diameter in patients with a clinical suspicion of raised intracranial pressure. Emerg Med J. 2011;28(8):679-81. doi:10.1136/ emj.2009.087353.
- Roque PJ, Wu TS, Barth L, et al. Optic nerve ultrasound for the detection of elevated intracranial pressure in the hypertensive patient. Am J Emerg Med. 2012;30(8):1357-63. doi: 10.1016/j.ajem.2011.09.025. Epub 2011 Dec 26. PMID: 22204998.
- Das SK, Shetty SP, Sen KK. A novel triage tool: Optic nerve sheath diameter in traumatic brain injury and its correlation to rotterdam computed tomography (CT) scoring. Polish J Radiol. 2017;82:240-43. doi:10.12659/PJR.900196.
- Raffiz M, Abdullah JM. Optic nerve sheath diameter measurement: a means of detecting raised ICP in adult traumatic and non-traumatic neurosurgical patients. Am J Emerg Med. 2017;35(1):150-53. doi:10.1016/ j.ajem.2016.09.044.
- Jeon JP, Lee SU, Kim SE, et al. Correlation of optic nerve sheath diameter with directly measured intracranial pressure in Korean adults using bedside ultrasonography. PLoS One. 2017;12(9):1-11. doi:10.1371/journal.pone.0183170.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 15, 2023 |
| Submission Date | February 15, 2022 |
| Published in Issue | Year 2023Volume: 62 Issue: 1 |
