Tayal Vivek S, Neulander Matthew, Norton H James, Foster Troy, Saunders Timothy, Blaivas Michael
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA.
Ann Emerg Med. 2007 Apr;49(4):508-14. doi: 10.1016/j.annemergmed.2006.06.040. Epub 2006 Sep 25.
Our objective is to determine whether a bedside ultrasonographic measurement of optic nerve sheath diameter can accurately predict the computed tomographic (CT) findings of elevated intracranial pressure in adult head injury patients in the emergency department (ED).
We conducted a prospective, blinded observational study on adult ED patients with suspected intracranial injury with possible elevated intracranial pressure. Exclusion criteria were age younger than 18 years or obvious ocular trauma. Using a 7.5-MHz ultrasonographic probe on the closed eyelids, a single optic nerve sheath diameter was measured 3 mm behind the globe in each eye. A mean binocular optic nerve sheath diameter greater than 5.00 mm was considered abnormal. Cranial CT findings of shift, edema, or effacement suggestive of elevated intracranial pressure were used to evaluate optic nerve sheath diameter accuracy.
Fifty-nine patients were enrolled in the study. Average age was 38 years, and median Glasgow Coma Scale score was 15 (interquartile 6 to 15). Eight patients with an optic nerve sheath diameter of 5.00 mm or more had CT findings that correlated with elevated intracranial pressure. The sensitivity for the ultrasonography in detecting elevated intracranial pressure was 100% (95% confidence interval [CI] 68% to 100%) and specificity was 63% (95% CI 50% to 76%). The sensitivity of ultrasonography for detection of any traumatic intracranial injury found by CT was 84% (95% CI 60% to 97%) and specificity was 73% (95% CI 59% to 86%).
Bedside ED optic nerve sheath diameter ultrasonography has potential as a sensitive screening test for elevated intracranial pressure in adult head injury.
我们的目的是确定在急诊科（ED）对成年颅脑损伤患者进行床旁超声测量视神经鞘直径是否能准确预测颅内压升高的计算机断层扫描（CT）结果。
我们对成年ED患者进行了一项前瞻性、盲法观察性研究，这些患者疑似颅内损伤且可能存在颅内压升高。排除标准为年龄小于18岁或有明显眼外伤。使用7.5兆赫超声探头在闭合眼睑上，于每只眼的眼球后3毫米处测量单眼视神经鞘直径。双眼平均视神经鞘直径大于5.00毫米被视为异常。采用提示颅内压升高的CT移位、水肿或脑沟消失结果来评估视神经鞘直径测量的准确性。
59名患者纳入研究。平均年龄38岁，格拉斯哥昏迷量表评分中位数为15分（四分位间距为6至15分）。8名视神经鞘直径为5.00毫米或更大的患者CT结果与颅内压升高相关。超声检查检测颅内压升高的敏感性为100%（95%置信区间[CI]为68%至100%），特异性为63%（95%CI为50%至76%）。超声检查检测CT发现的任何创伤性颅内损伤的敏感性为84%（95%CI为60%至97%），特异性为73%（95%CI为59%至86%）。
急诊科床旁视神经鞘直径超声检查有潜力作为成年颅脑损伤患者颅内压升高的敏感筛查试验。
