Can ocular ultrasound predict intracranial hypertension? A pilot diagnostic accuracy evaluation in a UK emergency department

• DOI: 10.1097/mej.0b013e32835105c8
• Publication Date: 2012-02-10T09:12:29Z
• Authors: Hasan Qayyum; Shammi Ramlakhan
• Keywords: Adult; Male; Reproducibility of Results; Optic Nerve; Pilot Projects; Middle Aged; 3. Good health; Cohort Studies; 03 medical and health sciences; Injury Severity Score; 0302 clinical medicine; Predictive Value of Tests; Brain Injuries; Confidence Intervals; Emergency Medicine; Humans; Female; Glasgow Coma Scale; Prospective Studies; Intracranial Hypertension; Emergency Service, Hospital; Hospitals, Teaching; Aged

Objective To determine if ultrasound guided measurement of the optic nerve sheath diameter accurately predicted elevated intracranial pressure (ICP) as demonstrated by cranial computed tomography (CT) in at-risk emergency department patients. Methods Optic diameters were measured on a convenience sample adult patients presenting with suspected ICP to large teaching hospital over 6-month period. A cut off for 5 mm was considered positive ICP. All had subsequent CT scan same day reported radiologist. Signs include midline shift mass effect at least 3 mm, sulcal effacement evidence significant oedema, collapse ventricles, and cisternal compression. Results Twenty-four recruited sensitivity 100% [95% confidence interval (CI), 83.8–100] specificity 75% (95% CI, 30.1–95.4) cut-off predict scan. The predictive value an increased 95.4% 74.13–99.75) negative 31–100). likelihood ratio wide calculated be 4.00 0.73–21.84). Conclusion This study shows that is sensitive specific test predicting prospective validation across departments would applicability this test. We propose algorithm incorporating management hypertension departments.