Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea.
Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea.
Resuscitation. 2019 May;138:59-67. doi: 10.1016/j.resuscitation.2019.03.004. Epub 2019 Mar 13.
We evaluated the diagnostic performance of optic nerve sheath diameter (ONSD) for prediction of neurologic outcome in post-cardiac arrest patients and relative prediction performance according to ONSD measurement modality.
PubMed and EMBASE databases were searched for diagnostic accuracy studies that used ocular ultrasound or brain computed tomography (CT) for prediction of neurologic outcome. Bivariate modelling and hierarchical-summary and receiver-operating-characteristic modelling were performed to evaluate diagnostic performance. A pooled diagnostic odds ratio with a 95% confidence interval not including 1 was considered informative. Subgroup analysis was performed according to the modality (ocular US vs. brain CT). Methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We performed meta-regression analyses for heterogeneity exploration.
Eight studies including 766 patients were included. For prediction of poor neurologic outcome, ONSD showed pooled sensitivity 0.41, pooled specificity 0.99, and area under the receiver-operating-characteristic curve 0.86. According to the pooled diagnostic odds ratios, ONSD was informative for prediction of neurologic outcome. In subgroup analysis, ONSD on ocular ultrasound showed significantly higher sensitivity and similar specificity than that on brain CT. On meta-regression analysis, locale, time to examination after return of spontaneous circulation, cause of cardiac arrest, and reference standard were sources of heterogeneity.
ONSD may be useful for predicting neurologic outcomes in post-cardiac arrest patients. Measuring the ONSD specifically using ocular ultrasound, application in patients with cardiac-origin cardiac arrest, and using the Glasgow-Pittsburgh Cerebral Performance Categories for neurologic outcome evaluation are recommended for more accurately predicting neurologic outcomes.
我们评估了视神经鞘直径（ONSD）对心脏骤停后患者神经功能预后的诊断性能，并根据 ONSD 测量方式评估了相对预测性能。
我们在 PubMed 和 EMBASE 数据库中检索了使用眼部超声或脑计算机断层扫描（CT）预测神经功能预后的诊断准确性研究。使用双变量模型和分层汇总及受试者工作特征模型评估诊断性能。汇总诊断比值比（DOR），95%置信区间不包括 1 被认为具有信息性。根据模态（眼部 US 与脑 CT）进行亚组分析。使用诊断准确性研究质量评估工具-2 评估方法学质量。我们进行了荟萃回归分析以探索异质性。
共纳入 8 项研究，包括 766 例患者。对于预测不良神经功能预后，ONSD 的汇总敏感性为 0.41，特异性为 0.99，受试者工作特征曲线下面积为 0.86。根据汇总 DOR，ONSD 对神经功能预后的预测具有信息性。在亚组分析中，眼部超声的 ONSD 显示出显著较高的敏感性和相似的特异性，而脑 CT 的 ONSD 则显示出较低的敏感性和较高的特异性。在荟萃回归分析中，地域、自主循环恢复后检查时间、心脏骤停原因和参考标准是异质性的来源。
ONSD 可能对预测心脏骤停后患者的神经功能预后有用。建议专门使用眼部超声测量 ONSD，应用于起源于心脏的心脏骤停患者，并使用格拉斯哥-匹兹堡脑功能表现分类对神经功能预后进行评估，以更准确地预测神经功能预后。
