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

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.

• Authors: Nawal Salahuddin, Alaa Mohamed, Nadia Alharbi, Hamad Ansari, Khaled J Zaza, Qussay Marashly, Iqbal Hussain, Othman Solaiman, Torbjorn V Wetterberg, Khalid Maghrabi
• Journal: BMC anesthesiology (BMC Anesthesiol) Vol. 16 Issue 1 Pg. 106 (10 25 2016) ISSN: 1471-2253 [Electronic] England
• PMID: 27776491 (Publication Type: Journal Article)

Topics

• Brain Edema (complications, epidemiology, physiopathology)
• Coma (diagnostic imaging, physiopathology)
• Female
• Humans
• Incidence
• Intensive Care Units
• Intracranial Hypertension (complications, diagnostic imaging, epidemiology)
• Intracranial Pressure (physiology)
• Male
• Middle Aged
• Optic Nerve (diagnostic imaging)
• Prospective Studies
• Saudi Arabia (epidemiology)
• Tomography, X-Ray Computed
• Ultrasonography