Department of Anesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Department of Anesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
J Emerg Med. 2022 Aug;63(2):200-211. doi: 10.1016/j.jemermed.2022.04.014. Epub 2022 Aug 26.
Ultrasonographic measurements of the diameter of the sheath of the optic nerve can be used to assess intracranial pressure indirectly. These measurements come with measurement error.
Our aim was to estimate observer's measurement error as a determinant of ultrasonographic measurement variability of the optic nerve sheath diameter.
A systematic search of the literature was conducted in Embase, Medline, Web of Science, the Cochrane Central Register of Trials, and the first 200 articles of Google Scholar up to April 19, 2021. Inclusion criteria were the following: healthy adults, B-mode ultrasonography, and measurements 3 mm behind the retina. Studies were excluded if standard error of measurement could not be calculated. Nine studies featuring 389 participants (median 40; range 15-100) and 22 observers (median 2; range 1-4) were included. Standard error of measurement and minimal detectable differences were calculated to quantify observer variability. Quality and risk of bias were assessed with the Guidelines for Reporting Reliability and Agreement Studies.
The standard error of measurement of the intra- and interobserver variability had a range of 0.10-0.41 mm and 0.14-0.42 mm, respectively. Minimal detectable difference of a single observer was 0.28-1.1 mm. Minimal detectable difference of multiple observers (range 2-4) was 0.40-1.1 mm. Quality assessment showed room for methodological improvement of included studies.
The standard errors of measurement and minimal detectable differences of ultrasonographic measurements of the optic nerve sheath diameter found in this review with healthy participants indicate caution should be urged when interpreting results acquired with this measurement method in clinical context.
视神经鞘直径的超声测量可间接用于评估颅内压。这些测量存在测量误差。
我们旨在评估观察者测量误差作为视神经鞘直径超声测量变异性的决定因素。
对 Embase、Medline、Web of Science、Cochrane 临床试验中央注册库和 Google Scholar 的前 200 篇文章进行了系统的文献检索，检索时间截至 2021 年 4 月 19 日。纳入标准为：健康成年人、B 型超声、视网膜后 3mm 处测量。如果无法计算测量的标准误差，则排除研究。纳入了 9 项研究，共 389 名参与者（中位数 40 岁；范围 15-100 岁）和 22 名观察者（中位数 2 名；范围 1-4 名）。计算测量的标准误差和最小可检测差异，以量化观察者的变异性。使用可靠性和一致性研究报告指南评估质量和偏倚风险。
观察者内和观察者间的测量变异性的标准误差的范围分别为 0.10-0.41mm 和 0.14-0.42mm。单个观察者的最小可检测差异为 0.28-1.1mm。多个观察者（范围 2-4 名）的最小可检测差异为 0.40-1.1mm。质量评估表明，纳入研究在方法学上有改进的空间。
本研究中健康参与者的视神经鞘直径超声测量的测量标准误差和最小可检测差异表明，在临床环境中使用该测量方法获取结果时应谨慎。
