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. 2016 Oct 25;16(1):106.
doi: 10.1186/s12871-016-0267-1.

The incidence of increased ICP in ICU patients with non-traumatic coma as diagnosed by ONSD and CT: a prospective cohort study

Nawal Salahuddin  1 , Alaa Mohamed  2 , Nadia Alharbi  2 , Hamad Ansari  2 , Khaled J Zaza  3 , Qussay Marashly  3 , Iqbal Hussain  2 , Othman Solaiman  2 , Torbjorn V Wetterberg  4 , Khalid Maghrabi  2
Affiliations

The incidence of increased ICP in ICU patients with non-traumatic coma as diagnosed by ONSD and CT: a prospective cohort study

Nawal Salahuddin et al. BMC Anesthesiol. .

Abstract

Background: Unexplained coma after critical illness can be multifactorial. We evaluated the diagnostic ability of bedside Optic Nerve Sheath Diameter [ONSD] as a screening test for non-traumatic radiographic cerebral edema.

Methods: In a prospective study, mixed medical-surgical intensive care units [ICU] patients with non-traumatic coma [GCS < 9] underwent bedside ultrasonographic ONSD measurements. Non-traumatic radiographic cerebral edema [NTRCE] was defined as > 5 mm midline shift, cisternal, sulcal effacement, or hydrocephalus on CT.

Results: NTRCE was identified in 31 of 102 patients [30.4 %]. The area under the ROC curve for detecting radiographic edema by ONSD was 0.785 [95 % CI 0.695-0.874, p <0.001]. ONSD diameter of 0.57 cm was found to be the best cutoff threshold with a sensitivity 84 % and specificity 71 %, AUC 0.785 [95 % CI 0.695-0.874, p <0.001]. Using ONSD as a bedside test increased the post-test odds ratio [OR] for NTRCE by 2.89 times [positive likelihood ratio], whereas post-test OR for NTRCE decreased markedly given a negative ONSD test [ONSD measurement less than 0.57 cm]; negative likelihood ratio 0.22.

Conclusions: The use of ONSD as a bedside test in patients with non-traumatic coma has diagnostic value in identifying patients with non-traumatic radiographic cerebral edema.

Keywords: Coma; Critical illness; Non-traumatic radiographic cerebral edema; Optic nerve sheath diameter.

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Figures

Fig. 1
Fig. 1
Optic nerve sheath diameter measurement by ultrasound
Fig. 2
Fig. 2
Final Cause of Coma
Fig. 3
Fig. 3
Bi-ocular correlations of optic nerve sheath diameter measurements; r2 value 0.86, p < 0.001
Fig. 4
Fig. 4
Receiver operating characteristics curve for discriminant optic nerve sheath diameter measurement for non-traumatic radiographic cerebral edema. AUC 0.785 [95 % CI 0.695–0.874, p <0.001]. Dashed line: Chance level; Vertical line [J] maximum value of Youden’s index for the ROC curve
See this image and copyright information in PMC

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