Optic Nerve Sheath Diameter Ultrasound for Raised Intracranial Pressure: A Literature Review and Meta‐analysis of its Diagnostic Accuracy. (24th April 2021)

• Record Type: Journal Article
• Authors: Aletreby, Waleed; Alharthy, Abdulrahman; Brindley, Peter G; Kutsogiannis, Demetrios J.; Faqihi, Fahad; Alzayer, Waseem; Balhahmar, Abdullah; Soliman, Ibrahim; Hamido, Hend; Alqahtani, Saleh A; Karakitsos, Dimitrios; Blaivas, Michael
• Is Part Of: Journal of ultrasound in medicine. Volume 41:Number 3(2022)
• Page Start: 585
• Page End: 595
• Publication Date: 2021-04-24
• Subjects: optic nerve sheath diameter -- ultrasound -- intracranial pressure -- meta‐analysis; Ultrasonics in medicine -- Periodicals; Ultrasonics; Ultrasonography; Ultrasonics in medicine; Electronic journals; Periodicals; Periodicals; 616.07543
• DOI: 10.1002/jum.15732
• Languages: English
• ISSNs: 0278-4297

Abstract

Abstract : 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. Method: 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. Results: 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). Conclusion: ONSD is a useful adjunct in ICP evaluation but is currently not a replacement for invasive methods where they are feasible.