Copyright
©The Author(s) 2024.
World J Crit Care Med. Sep 9, 2024; 13(3): 97205
Published online Sep 9, 2024. doi: 10.5492/wjccm.v13.i3.97205
Published online Sep 9, 2024. doi: 10.5492/wjccm.v13.i3.97205
Study characteristic | Number of studies, n = 37 |
Year of publication | |
2013 | 1 (2.7) |
2014 | 3 (8.1) |
2015 | 5 (13.5) |
2016 | 3 (8.1) |
2017 | 4 (10.8) |
2018 | 2 (5.4) |
2019 | 4 (10.8) |
2020 | 1 (2.7) |
2021 | 3 (8.1) |
2022 | 2 (5.4) |
2023 | 7 (18.9) |
2024 | 2 (5.4) |
Country of origin | |
China | 8 (21.6) |
India | 7 (18.9) |
Turkey | 5 (13.5) |
South Korea | 3 (8.1) |
Iran | 2 (5.4) |
Brazil | 2 (5.4) |
Italy | 2 (5.4) |
United States | 2 (5.4) |
Uganda | 1 (2.7) |
Spain | 1 (2.7) |
Saudi Arabia | 1 (2.7) |
Greece | 1 (2.7) |
South Africa | 1 (2.7) |
Germany | 1 (2.7) |
Comparator parameter | |
Intraventricular ICP monitoring | 3 (8.1) |
CSF opening pressure for lumbar puncture | 20 (54) |
MRI/CT scans | 14 (37.8) |
Type of study | |
Prospective observational study | 17 (45.9) |
Prospective case control study | 12 (32.4) |
Prospective cohort study | 4 (10.8) |
Retrospective case study | 2 (5.4) |
Case reports | 2 (5.4) |
Ref. | Country | Type of study | Number of participants | Patient characteristics | Comparator parameter and P value, r value | ONSD cut off, AUROC | Results | Limitations |
Amini et al[7], 2013 | Iran | Descriptive prospective | 50 | Non-traumatic patients requiring lumbar puncture | CSF pressure on LP, (P = 0.05; r = 0.88) | 5.5, NA | The ONSD of greater than 5.5 mm predicted an ICP of ≥ 20 cmH2O with sensitivity and specificity of 100% (95%CI: 100-100) (P = 0.001) | Small sample size |
Caffery et al[8], 2014 | United States | Prospective observational trial | 51 | Non-traumatic causes of raised ICP | Opening pressure on LP, r = 0.53 | > 5.0 mm, 0.69 | Sensitivity 0.75, specificity of 0.44 | Use of a convenience sample could introduce bias. Sample size was small with large confidence intervals. One physician with specialized training, patients were not matched for demographic variables such as age or sex |
Nabeta et al[9], 2014 | Uganda | Prospective descriptive study | 57 | HIV positive, ART naïve adults suspected with meningitis | CSF opening pressure, P < 0.001 | 5 | Sensitivity 86% and specificity 63% for predicting a CSF ICP > 200 mm PPV was 77% and NPV was 75%. Also, in ONSD > 5mm had a RR of 2.39 for IICP > 200 cmH2O | Inter-operator variability, with training being essential |
Shirodkar et al[10], 2014 | India | Prospective, observational case control study | 101, 60 study, 41 control | Non traumatic cause of increased ICP | Increased ICP on CT/MRI, P < 0.001 | 4.71, 0.986 | Sensitivity of 77.8% and specificity of 100% | Small size |
Wang l et al[11], 2015 | China | Prospective observational cohort study | 279 | Non-traumatic cause of increased ICP | CSF opening pressure, P < 0.001 | 4.1, 0.965 | Sensitivity of 95% and a specificity of 92% | Average of 8 measurements of ONSD to decrease variability. May not be feasible practically |
Du Toit et al[12], 2015 | South Africa | Prospective observational study | 76 | Meningitis | CSF opening pressure, Cohen’s kappa was 0.41 | 4.8, 0.73 | Sensitivity of 50% and specificity of 89.8% PPV of 54.8% and NPV of 88.3% PLR of 4.92 and NLR of 0.56 | The study was unable to establish inter-observer variability owing to the large number of operators and the small number of patients with increased ICP |
Sangani et al[13], 2015 | India | Prospective observational study | 25 | Tubercular meningitis | CSF opening pressure, P < 0.001 | NA | Those patients with TBME had a mean ONSD of 5.81 mm | Small sample size |
Singleton et al[14], 2015 | United States | Case report | 1 | Idiopathic ICH | CSF opening and closing pressure which was 36 cm H2O and 19.5 cm H2O after removal of 19 cc of CSF | NA | Pre-LP ONSD of left and right eye were 72 and 6.8 mm, respectively. Second study after 30 minutes left and right ONSD were 58 and 6.2 mm, respectively | |
Karzamni et al[15], 2015 | Iran | Prospective case control study | 60, 30 cases and 30 controls | Intracranial SOL and ICH | Increased ICP on CT, P < 0.001 | 4.53 | Sensitivity and specificity of 100%. ONSD was the most sensitive and specific parameter, followed by RI, PI and EDV. ONSD correlated significantly with GCS (r = −0.40, P = 0.003) and ventricular shift on CT images (r = 0.37, P = 0.02) | Small size, lack of direct ICP measurement |
Komut et al[16], 2016 | Turkey | Prospective case control study | 100 | Nontraumatic intracranial event in ED | Increased ICP on CT, P < 0.05 | 5.3, 0.728 | Sensitivity 70%, specificity 74% | Lack of direct ICP measurement |
del Saz-Saucedo et al[17], 2016 | Spain | Prospective case control study | 30 | IIH | CSF opening pressure, P = 0.005 | 6.3 to predict CSF pressure of 25, 0.93 | Sensitivity 94.7%, specificity 90.9% and PLR of 10.4. After a therapeutic lumbar puncture an 87% of cases had a partial reduction of ONSD values | Small size |
Salahudd et al[1], 2016 | Saudi Arabia | Prospective cohort study | 102 | Non traumatic raised ICP | Increased ICP on CT, P < 0.001 | 5.7, 0.785 | Sensitivity 84 % and specificity 71%. PLR = 2.89, NLR = 0.22 | Study did not include a detailed neurological exam or record any specific localizing neurologic signs, individual GCS |
Jeon et al[18], 2017 | Korea | Prospective case control study | 62 | Nontraumatic cases requiring EVD placement | Opening pressure on EVD insertion, P < 0.01 | > 5.6, 0.936 | Sensitivity of 93.75% and a specificity of 86.67% for identifying increased ICP | To reduce selection bias, patients with severely increased ICP which required emergency surgical decompression before ICP monitor insertion. Study reflects increased ICP due to moderate hematoma in a Korean population |
Gökcen et al[19], 2017 | Turkey | Retrospective comparative study | 191 | Acute ischemic stroke | Raised ICP on CT, P < 0.001 | Right ONSD 5.4, 0.941, Left ONSD 5.3, 0.922 | CVD subgroups were compared with the control group the highest ONSD was in TACI group and the lowest was in LACI group (P < 0.001) | Unequal number of cases in the subgroups and adjustment of baseline charecteristics not mentioned |
Wang et al[20], 2017 | China | Prospective case control study | 316 | Nontraumatic increased ICP requiring LP | CSF opening pressure, r = 0.758, P < 0.001 | NA | Xing and Wang mathematical equation for predicted ICP = −111.92 + 77.36 × ONSD (Durbin-Watson value = 1.94) | Equation may underestimate the true ICP value in patients with extremely high ICP. The Bland-Altman analysis in this study suggested that any estimate might be deviate by as much as ± 80mmH2O |
Liu et al[21], 2017 | China | Prospective observational study | 110 | Non-traumatic increased ICP requiring LP | CSF opening pressure, P < 0.001 | 5.6, 0.861 | Sensitivity of 86.2% and specificity of 73.1% | 5%–15% of the cases were classified |
Wang et al[22], 2018 | China | Prospective case and control study | 60 | Nontraumatic causes of IICP requiring LP | CSF opening pressure, P < 0.001. The ultrasonographic ONSD and ICP were measured on admission and follow-up | NA | ONSD was strongly correlated with ICP (r = 0.702, P < 0.001) | Small size, ONSD cut off not obtained |
Canakci et al[24], 2018 | Turkey | Prospective case control study | 100 | Non-traumatic headache presenting to ER | Raised ICP on CT, P < 0.001 | 5.5, NA | ONSD value in the ipsilateral side with the lesion was significantly higher than the contralateral side (P < 0.001). Discharge, clinical hospitalization, referral, ICU stay, emergency surgery | ER based study including patients with nontraumatic headache not exclusively patients with clinical features of raised ICP. No AUROC calculated |
Naldi et al[24], 2019 | Italy | Prospective case control study | 46 cases, 40 controls | Primary ICH | Increased ICP on CT, P < 0.01 | 5.6, 1.0 | Sensitivity 100%, Specificity 100% | ICP was presumed to be normal in control, limited predictive value of abnormal CT findings. Second CT scan was performed not on a given day, but depending on clinical conditions |
Gupta et al[25], 2019 | India | Prospective observational study | 100 | Raised ICP requiring LP | CSF opening pressure, P < 0.001 | 6.3 to predict CSF pressure of > 20 cm of water | Sensitivity 77.3%, specificity 92.3%, PLR = 10.05, NLR = 0.25 | Did not include any condition causing a mass effect, malignant infarcts, ICH or obstructive hydrocephalus |
Gupta et al[26], 2019 | India | Retrospective case series study | 100 | Raised ICP requiring LP | CSF opening pressure, P < 0.001 | 4.8 | Sensitivity of 85% and specificity of 88% | Single center, retrospective, small size |
Wang et al[27], 2019 | China | Case reports | 2 | Venous sinus stenosis and venous sinus thrombosis | CSF opening pressure | NA | Case 1 A predicted ICP by ONSD was 346 mmH2O. and CSF opening pressure was 355 mmH2O. Case 2 ONSD was 5.95 mm with CSF opening pressure higher than 400 mmH2O | |
Zoerle et al[28], 2020 | Italy | Prospective observational study | 20 | Aneurysmal SAH with EVD | Intraventricular ICP, P > 0.05 | NA | ONSD measurements were accurate, very similar to the diameters measured by MRI (the mean difference in the Bland–Altman plot was 0.08 mm, 95% limits of agreement: −1.13; + 1.23 mm). No clear relationship was detectable between the ICP and ONSD, and a linear regression model showed an angular coefficient very close to 0 (P > 0.05). US-ONSD and ICP values were in agreement after CSF drainage and shifts in ICP in a limited number of patients | Measured ICP in the ICU after the patients were stabilized, the aneurysm repaired, and large intracerebral hematomas surgically removed, with EVD and CSF drainage. As a consequence, the ICP values in our cohort were relatively low for the majority of cases |
Sahu et al[29], 2021 | India | Prospective, double blinded observational study | 30 | Nontraumatic increased ICP | Direct intraventricular ICP, P = 0.01 | 5.5 to predict ICP > 20 mmHg, 0.904 | Sensitivity 100% and specificity 75%. The ONSD values predicting ICP at 25-, 30-, and 35-mm Hg were was 6.3 mm, 6.5 mm, and 6.7 mm, respectively | Small number of patients having ICP > 30 mm of Hg, appropriate ONSD values could not be predicted |
Yildiz et al[30], 2021 | Turkey | Prospective, observational study | 82 | Acute ischaemic stroke | Increased ICP on CT, P < 0.05 | NA | ONSD on the 3rd day and 5th day was larger (> 5 mm) than on first day (P < 0.05). In the patients who received tPA right eye ONSD on the 5th day were significantly raised P < 0.05) | ONSD only after the symptoms started, and were also not measured during the decline periods and response to treatment |
Kim et al[31], 2021 | South Korea | Prospective, observational study | 199 | Suspected raised ICP | Increased ICP on CT, P < 0.001 | 5.3, 0.903 | Sensitivity of 75.4%, specificity of 90.8%, PPV of 76.8%, and NPV of 90.2% | Single centre, 2 observers hence there can be variability |
Qamar Akhtar et al[32], 2022 | India | Prospective case control study | 100 | Non traumatic emergencies with suspected raised ICP | Raised ICP on CT/MRI (P = 0.05; r = 0.88) | ≥ 6.3, 0.956 | Sensitivity of 100%, specificity of 89.2%, PPV of 83.3%, NPV of 100%, and diagnostic accuracy of 93% for detection of raised ICP by bedside USG ONSD measurement compared to CT/MRI brain | CT or MRI brain scan which is an indirect indicator of raised ICP, and use of a high ONSD mean value (mm) cut-off |
Oliveira et al[33], 2022 | Brazil | Prospective observational study | 40 | Malignant MCA infarct requiring decompressive craniotomy | Increased ICP on CT, P: NA | 5.4 mm, ROC for, Right eye: 0.82, Left eye: 0.77 | Post craniectomy, there was a decrease in the mean value of 1.04mm in the right eye 086 mm in left. (P = 0.003) | Small size, CT unreliable for increased ICP. DC individualized is routinely adopted at this center, the neurosurgical team was allowed to perform surgery using individual interpretations of criteria, with controversial decisions on some patients |
Roemer et al[34], 2022 | Germany | Prospective observational study | 23 | Increased ICH | CSF opening pressure, P = 0.9 | NA | No correlation between CSF opening pressure and ONSD was found | Small size, results could be biased by the ongoing treatment of the patients |
Bhide et al[35], 2023 | India | Prospective observational study | 114 | Non-traumatic causes of raised ICP | Increased ICP on CT/MRI, P < 0.001 | 5.75, 0.844 | Sensitivity and specificity of 77.55% and 89.06%. PLR and NLR of 7.09 and 0.25 | Comparator used was CT or MRI brain scan which is an indirect indicator of raised ICP, and use of a high ONSD mean value (mm) cut-off |
Yu et al[36], 2023 | China | Prospective observational study | 107 | Non traumatic increased ICP requiring LP | CSF opening pressure, P < 0.001 | 6.3 mm | 73% sensitivity and 83% specificity, ODH with ONSD showed the highest value under the receiver operating characteristic curve of 0.965 with a sensitivity of 93% and a specificity of 92% | Single lumbar puncture |
Batur et al[37], 2023 | Turkey | Prospective case control study | 105 | Acute ischemic stroke | Features of raised ICP on MRI (P < 0.001) | 5.05, 0.978 | Sensitivity 96.8%, specificity 95.6%. The cut-off for need for treatment 4.95 mm with AUC of 0.807 (sensitivity = 71.4%, specificity = 79.6%) | Single-centered study. Although 30-day mortality rates were recorded, a detailed information about the outcome could be given by monitoring the neurological healing rate and time of the patients |
Li et al[38], 2023 | China | Prospective observational study | 56 | Suspected encephalitis | CSF pressure, r = 0.769, P < 0.01 | NA | Both ODH and ONSD had the ability to predict ICP (P < 0.05), but with time factors, ONSD displayed a stronger ability to predict ICP than ODH | Single-center design and small sample size. Cut-off value with AUROC not calculated |
de Moraes et al[39], 2023 | Brazil | Prospective observation study | 18 | Acute stroke (ischemic and hemorrhagic) | A 5-point visual scale for n raised ICP on CT and two parameters (time-to-peak and P2/P1 ratio) of a noninvasive ICP wave morphology monitor (r = 0.29) | 5.2, 0.69 | Sensitivity was 71.4%, the specificity was 70.4%, the PPV was 43.5%, and the NPV was 88.6% | Small size, assessment intervals varied, Non blinded, correlation modest to moderate strengths |
Cheng et al[40], 2023 | China | Prospective cohort study | 223 | Non-traumatic causes of raised ICP requiring LP | CSF opening pressure, P < 0.001 | 5.47, 0.933 | ICP values were strongly correlated with ONSD, ONSD, and ONSD/ETD. ONSD and OND combined model predicted ICP = 139.394 × ONSD-112.428 × OND267.461 prediction accuracy was the highest. (ICC = 0.88) | Underestimated the ICP in very high cases, the maximum limit of our ICP values was 330 mmH2O, and values greater than 330 mmH2O were counted as 330 mmH2O |
Bakola et al[41], 2024 | Greece | Prospective center case-control study | 31 case and 34 controls | Idiopathic ICH | CSF opening pressure on LP, (r = 0.716, P < 0.001) | 5.15, 0.914 | Sensitivity and specificity of TOS for diagnosis of IIH were 85% (95%CI: 66%-95%) and 90% (95%CI: 76%-98%), respectively. PPV 83% (95%CI: 74%-96%), NPV 94% (95%CI: 83-98%) | Subsequent measurements to estimate the potential treatment response using TOS were not part of our study protocol. |
Kim et al[42], 2024 | Korea | Retrospective analysis of prospectively gathered data ONSD measurements were conducted using a handheld ultrasonography device during the course of endovascular treatment | 126 | Aneurysmal SAH | CSF opening pressure on LP, (P < 0.001), the association between ONSD and ICP was validated through the application of a linear regression machine learning model. The correlation between ICP and various factors was explored through the modeling | 5.45, 0.90, SHAP 5.58 | Sensitivity 92.50, specificity 78.00, PPV 82.70 NPV 90.20 | Small size, single center |
Related issues | |
How to measure ONSD? | |
(1) | A scan or B scan? What is blooming effect? |
(2) | CLOSED protocol? |
(3) | Transverse or horizontal? |
(4) | How many values before obtaining a mean? |
(5) | ONSD or OND or ratio? |
What is the body of evidence in various subset of patients? | |
(1) | Acute ischemic stroke and CVST |
(2) | Acute hemorrhagic stroke |
(3) | Hydrocephalus |
(4) | Idiopathic intracranial hemorrhage |
(5) | Meningitis |
(6) | Septic metabolic encephalopathy |
Can ONSD be used as a management tool? | |
Can ONSD be a reliable outcome measure? | |
(1) | Post cardiac arrest |
(2) | Dysnatremia |
A scan | B scan |
Amplitude modulation scan | Brightness modulation scan |
8 mHertz frequency with small non focused probe | 10 mHertz with a larger focused probe |
One-dimensional image of spikes of varying amplitudes along a baseline | Two-dimensional image |
Provides quantitative information: Ex length of eyeball before surgery. | Provides topographical information |
Basis of ocular biometry | Evaluation of ocular pathology |
No blooming effect | Blooming effect while measuring ONSD |
Not available as bedside equipment | Part of point-of-care ultrasonography, easily available |
- Citation: Bhide M, Juneja D, Singh O, Mohanty S. Optic nerve sheath diameters in nontraumatic brain injury: A scoping review and role in the intensive care unit. World J Crit Care Med 2024; 13(3): 97205
- URL: https://www.wjgnet.com/2220-3141/full/v13/i3/97205.htm
- DOI: https://dx.doi.org/10.5492/wjccm.v13.i3.97205