From the Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland.
Department of Anaesthesia, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
Anesth Analg. 2021 Mar 1;132(3):686-695. doi: 10.1213/ANE.0000000000005189.
Although invasive monitoring is the standard method for intracranial pressure (ICP) measurement, it is not without potential for serious complications. Noninvasive methods have been proposed as alternatives to invasive ICP monitoring. The study aimed to investigate the diagnostic accuracy of the currently available noninvasive methods for intracranial hypertension (ICH) monitoring.
We searched 5 databases for articles evaluating the diagnostic accuracy of noninvasive methods in diagnosing ICH in PubMed, Institute of Science Index, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase. The quantitative analysis was conducted if there were at least 2 studies evaluating a specific method. The accuracy measures included the sensitivity, specificity, likelihood ratios, and diagnostic odds ratio.
We included 134 articles. Ultrasonographic optic nerve sheath diameter (US ONSD) had high diagnostic accuracy (estimated sensitivity of 90%; 95% confidence interval [CI], 87-92, estimated specificity of 88%; 95% CI, 84-91) while the magnetic resonance imaging (MRI) ONSD had estimated sensitivity of 77%; 95% CI, 64-87 and estimated specificity of 89%; 95% CI, 84-93, and computed tomography (CT) ONSD had estimated sensitivity of 93%; 95% CI, 90-96 and estimated specificity of 79%; 95% CI, 56-92. All MRI signs had a very high estimated specificity ranging from 90% to 99% but a low estimated sensitivity except for sinus stenosis which had high estimated sensitivity as well as specificity (90%; 95% CI, 75-96 and 96%; 95% CI, 91-99, respectively). Among the physical examination signs, pupillary dilation had a high estimated specificity (86%; 95% CI, 76-93). Other diagnostic tests to be considered included pulsatility index, papilledema, transcranial Doppler, compression or absence of basal cisterns, and ≥10 mm midline shift. Setting the cutoff value of ICH to ≥20 mm Hg instead of values <20 mm Hg was associated with higher sensitivity. Moreover, if the delay between invasive and noninvasive methods was within 1 hour, the MRI ONSD and papilledema had a significantly higher diagnostic accuracy compared to the >1 hour subgroup.
Our study showed several promising tools for diagnosing ICH. Moreover, we demonstrated that using multiple, readily available, noninvasive methods is better than depending on a single sign such as physical examination or CT alone.
尽管有创监测是颅内压（ICP）测量的标准方法，但它并非没有严重并发症的潜在风险。非侵入性方法已被提出作为有创 ICP 监测的替代方法。本研究旨在调查目前用于颅内高压（ICH）监测的非侵入性方法的诊断准确性。
我们在 PubMed、Institute of Science Index、Scopus、Cochrane Central Register of Controlled Trials（CENTRAL）和 Embase 这 5 个数据库中搜索了评估非侵入性方法诊断 ICH 准确性的文章。如果至少有 2 项研究评估了特定方法，则进行定量分析。准确性测量指标包括灵敏度、特异性、似然比和诊断比值比。
我们纳入了 134 篇文章。超声视神经鞘直径（US ONSD）具有较高的诊断准确性（估计灵敏度为 90%；95%置信区间[CI]，87-92，估计特异性为 88%；95%CI，84-91），而磁共振成像（MRI）ONSD 的估计灵敏度为 77%；95%CI，64-87，特异性为 89%；95%CI，84-93，CT ONSD 的估计灵敏度为 93%；95%CI，90-96，特异性为 79%；95%CI，56-92。所有 MRI 征象的特异性估计值均非常高，范围为 90%至 99%，但敏感性估计值较低，除了窦狭窄，其具有高的敏感性和特异性（90%；95%CI，75-96 和 96%；95%CI，91-99）。在体格检查征象中，瞳孔扩张具有较高的特异性（86%；95%CI，76-93）。其他要考虑的诊断测试包括脉动指数、视盘水肿、经颅多普勒、基底池受压或缺失以及≥10mm 的中线移位。将 ICH 的截止值设定为≥20mmHg 而不是<20mmHg 与更高的灵敏度相关。此外，如果有创和非侵入性方法之间的延迟时间在 1 小时内，MRI ONSD 和视盘水肿与>1 小时亚组相比，具有更高的诊断准确性。
我们的研究表明了几种有前途的诊断 ICH 的工具。此外，我们还表明，使用多种、易于获得的非侵入性方法比仅依赖于单一征象（如体格检查或 CT）更好。
