床旁视神经鞘直径测量在急诊科鉴别诱发性发作与非诱发性发作中的疗效。
Efficacy of bedside optic nerve sheath diameter measurement in differentiating provoked seizure from unprovoked seizure in the emergency department.
机构信息
From the Department of Emergency Medicine, Antalya Training and Research Hospital, Antalya, Turkiye.
From the Department of Emergency Medicine, Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Ankara, Turkiye.
出版信息
Ann Saudi Med. 2023 Jan-Feb;43(1):42-49. doi: 10.5144/0256-4947.2023.42. Epub 2023 Feb 2.
BACKGROUND
Emergency departments (EDs) are typically the first medical contact for seizure patients, and early diagnosis and treatment is primarily the responsibility of emergency physicians.
OBJECTIVES
Demonstrate the efficacy of bedside ocular ultrasonography for optic nerve sheath diameter (ONSD) measurement in differentiating provoked seizure from unprovoked seizure in the ED.
DESIGN
Prospective observational study SETTINGS: Tertiary care hospital PATIENTS AND METHODS: Patients presenting to the ED with seizure were divided into two groups according to medical history, physical examination, laboratory results, cranial computed tomography findings and electroencephalography results. Patients with seizures that did not have a specific cause (unprovoked) were compared with patients who had seizures caused by underlying pathology (provoked). The measurement of the ONSD was taken at the bedside within 30 minutes of arrival. The study compared the ONSD values, age, sex, type of seizure, and Glasgow Coma Score between the two groups.
MAIN OUTCOME MEASURE
Efficacy of ONSD to distinguish between provoked and unprovoked seizures.
SAMPLE SIZE
210 patients RESULTS: One hundred and fourteen (54.3%) patients were in the provoked seizure group and 96 (45.7%) were in the unprovoked seizure group. The ONSD measurements were significantly higher in the provoked seizure group compared with the unprovoked seizure group (median 6.1 mm vs. 5.2 mm, <.001). The cut-off value of ONSD higher than 5.61 was significantly associated with the prediction of the provoked seizure (<.001). The area under the curve value was 0.882 (95% CI: 0.830-0.922) with a sensitivity of 86.5 and specificity of 78.9%.
CONCLUSIONS
Bedside ONSD measurement by means of ocular ultrasound is an effective method for differentiating provoked seizure from unprovoked seizure.
LIMITATIONS
Statistical significance of age on ONSD and exclusion of pediatric patients.
CONFLICT OF INTEREST
None.
背景
急诊科通常是癫痫患者的第一医疗接触点，早期诊断和治疗主要是急诊医生的责任。
目的
展示床边眼部超声测量视神经鞘直径（ONSD）在急诊科区分诱发性癫痫与自发性癫痫的疗效。
设计
前瞻性观察研究
设置
三级保健医院
患者和方法
根据病史、体格检查、实验室结果、头颅计算机断层扫描结果和脑电图结果，将就诊于急诊科的癫痫患者分为两组。将无特定病因（自发性）的癫痫患者与由潜在病理引起的癫痫患者（诱发性）进行比较。在到达后 30 分钟内床边进行 ONSD 测量。研究比较了两组患者的 ONSD 值、年龄、性别、癫痫类型和格拉斯哥昏迷评分。
主要观察指标
ONSD 区分诱发性和自发性癫痫的效果。
样本量
210 例
结果
114 例（54.3%）患者为诱发性癫痫组，96 例（45.7%）为自发性癫痫组。与自发性癫痫组相比，诱发性癫痫组的 ONSD 测量值明显更高（中位数 6.1mm 比 5.2mm，<.001）。高于 5.61 的 ONSD 截断值与诱发性癫痫的预测显著相关（<.001）。曲线下面积值为 0.882（95%CI：0.830-0.922），灵敏度为 86.5%，特异性为 78.9%。
结论
床边 ONSD 通过眼部超声测量是区分诱发性癫痫与自发性癫痫的有效方法。
局限性
ONSD 与年龄的统计学意义和排除儿科患者。
利益冲突
无。
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