Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy.
Neurosciences Critical Care Unit, Addenbrooke's Hospital, University of Cambridge, Box 1, Hills Road, CB2 0QQ, Cambridge, UK.
Intensive Care Med. 2018 Aug;44(8):1284-1294. doi: 10.1007/s00134-018-5305-7. Epub 2018 Jul 17.
Although invasive intracranial devices (IIDs) are the gold standard for intracranial pressure (ICP) measurement, ultrasonography of the optic nerve sheath diameter (ONSD) has been suggested as a potential non-invasive ICP estimator. We performed a meta-analysis to evaluate the diagnostic accuracy of sonographic ONSD measurement for assessment of intracranial hypertension (IH) in adult patients.
We searched on electronic databases (MEDLINE/PubMed, Scopus, Web of Science, ScienceDirect, Cochrane Library) until 31 May 2018 for comparative studies that evaluated the efficacy of sonographic ONSD vs. ICP measurement with IID. Data were extracted independently by two authors. We used the QUADAS-2 tool for assessing the risk of bias (RB) of each study. A diagnostic meta-analysis following the bivariate approach and random-effects model was performed.
Seven prospective studies (320 patients) were evaluated for IH detection (assumed with ICP > 20 mmHg or > 25 cmHO). The accuracy of included studies ranged from 0.811 (95% CI 0.678‒0.847) to 0.954 (95% CI 0.853‒0.983). Three studies were at high RB. No significant heterogeneity was found for the diagnostic odds ratio (DOR), positive likelihood ratio (PLR) and negative likelihood ratio (NLR), with I < 50% for each parameter. The pooled DOR, PLR and NLR were 67.5 (95% CI 29‒135), 5.35 (95% CI 3.76‒7.53) and 0.088 (95% CI 0.046‒0.152), respectively. The area under the hierarchical summary receiver-operating characteristic curve (AUHSROC) was 0.938. In the subset of five studies (275 patients) with IH defined for ICP > 20 mmHg, the pooled DOR, PLR and NLR were 68.10 (95% CI 26.8‒144), 5.18 (95% CI 3.59‒7.37) and 0.087 (95% CI 0.041‒0.158), respectively, while the AUHSROC was 0.932.
Although the wide 95% CI in our pooled DOR suggests caution, ultrasonographic ONSD may be a potentially useful approach for assessing IH when IIDs are not indicated or available (CRD42018089137, PROSPERO).
尽管有创颅内装置（IIDs）是颅内压（ICP）测量的金标准，但视神经鞘直径（ONSD）超声检查已被提议作为一种潜在的非侵入性 ICP 估计方法。我们进行了一项荟萃分析，以评估超声测量 ONSD 对成人颅内高压（IH）评估的诊断准确性。
我们在电子数据库（MEDLINE/PubMed、Scopus、Web of Science、ScienceDirect、Cochrane Library）中进行了搜索，截至 2018 年 5 月 31 日，以评估超声 ONSD 与 IID 测量的比较研究。两位作者独立提取数据。我们使用 QUADAS-2 工具评估每个研究的偏倚风险（RB）。采用双变量方法和随机效应模型进行诊断性荟萃分析。
有 7 项前瞻性研究（320 名患者）评估了 IH 检测（假设 ICP>20mmHg 或>25cmH2O）。纳入研究的准确性范围为 0.811（95%CI 0.678-0.847）至 0.954（95%CI 0.853-0.983）。三项研究的 RB 较高。对于诊断比值比（DOR）、阳性似然比（PLR）和阴性似然比（NLR），没有发现显著的异质性，每个参数的 I<50%。汇总的 DOR、PLR 和 NLR 分别为 67.5（95%CI 29-135）、5.35（95%CI 3.76-7.53）和 0.088（95%CI 0.046-0.152）。分层汇总受试者工作特征曲线下面积（AUHSROC）为 0.938。在 5 项研究（275 名患者）中，将 IH 定义为 ICP>20mmHg，汇总的 DOR、PLR 和 NLR 分别为 68.10（95%CI 26.8-144）、5.18（95%CI 3.59-7.37）和 0.087（95%CI 0.041-0.158），AUHSROC 为 0.932。
尽管我们汇总的 DOR 较宽的 95%CI 表明需要谨慎，但在无法或无法使用 IIDs 时，超声 ONSD 可能是评估 IH 的一种潜在有用方法（CRD42018089137，PROSPERO）。
