Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.
Neurocritical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.
J Ultrasound Med. 2022 Mar;41(3):585-595. doi: 10.1002/jum.15732. Epub 2021 Apr 24.
Optic nerve sheath diameter (ONSD) ultrasound is becoming increasingly more popular for estimating raised intracranial pressure (ICP). We performed a systematic review and analysis of the diagnostic accuracy of ONSD when compared to the standard invasive ICP measurement.
We performed a systematic search of PUBMED and EMBASE for studies including adult patients with suspected elevated ICP and comparing sonographic ONSD measurement to a standard invasive method. Quality of studies was assessed using the QUADAS-2 tool by two independent authors. We used a bivariate model of random effects to summarize pooled sensitivity, specificity, and diagnostic odds ratio (DOR). Heterogeneity was investigated by meta-regression and sub-group analyses.
We included 18 prospective studies (16 studies including 619 patients for primary outcome). Only one study was of low quality, and there was no apparent publication bias. Pooled sensitivity was 0.9 [95% confidence intervals (CI): 0.85-0.94], specificity was 0.85 (95% CI: 0.8-0.89), and DOR was 46.7 (95% CI: 26.2-83.2) with partial evidence of heterogeneity. The Area-Under-the-Curve of the summary Receiver-Operator-Curve was 0.93 (95% CI: 0.91-0.95, P < .05). No covariates were significant in the meta-regression. Subgroup analysis of severe traumatic brain injury and parenchymal ICP found no heterogeneity. ICP and ONSD had a correlation coefficient of 0.7 (95% CI: 0.63-0.76, P < .05).
ONSD is a useful adjunct in ICP evaluation but is currently not a replacement for invasive methods where they are feasible.
视神经鞘直径（ONSD）超声在评估颅内压升高（ICP）方面越来越受欢迎。我们对 ONSD 与标准侵入性 ICP 测量相比的诊断准确性进行了系统评价和分析。
我们对 PUBMED 和 EMBASE 进行了系统搜索，纳入了疑似 ICP 升高的成年患者的研究，并将超声 ONSD 测量与标准侵入性方法进行了比较。两位独立作者使用 QUADAS-2 工具评估了研究的质量。我们使用双变量随机效应模型汇总了汇总敏感性、特异性和诊断优势比（DOR）。通过meta 回归和亚组分析来研究异质性。
我们纳入了 18 项前瞻性研究（16 项研究共纳入 619 例患者作为主要结局）。只有一项研究质量较低，且没有明显的发表偏倚。汇总敏感性为 0.9[95%置信区间（CI）：0.85-0.94]，特异性为 0.85（95%CI：0.8-0.89），DOR 为 46.7（95%CI：26.2-83.2），存在部分异质性。汇总受试者工作特征曲线下面积为 0.93（95%CI：0.91-0.95，P<.05）。meta 回归中无协变量有统计学意义。严重创伤性脑损伤和实质 ICP 的亚组分析未发现异质性。ICP 和 ONSD 的相关系数为 0.7（95%CI：0.63-0.76，P<.05）。
ONSD 是 ICP 评估的有用辅助手段，但在可行的情况下，目前不能替代侵入性方法。
