Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis

Chiara Robba; Gregorio Santori; Marek Czosnyka; Francesco Corradi; Nicola Bragazzi; Llewellyn Padayachy; Fabio Silvio Taccone; Giuseppe Citerio

doi:10.1007/s00134-018-5305-7

Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis

Intensive Care Med. 2018 Aug;44(8):1284-1294. doi: 10.1007/s00134-018-5305-7. Epub 2018 Jul 17.

Authors

Chiara Robba^{1

2}, Gregorio Santori³, Marek Czosnyka^{4

5}, Francesco Corradi⁶, Nicola Bragazzi⁷, Llewellyn Padayachy⁸, Fabio Silvio Taccone⁹, Giuseppe Citerio¹⁰

Affiliations

¹ Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy. kiarobba@gmail.com.
² Neurosciences Critical Care Unit, Addenbrooke's Hospital, University of Cambridge, Box 1, Hills Road, CB2 0QQ, Cambridge, UK. kiarobba@gmail.com.
³ Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
⁴ Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
⁵ Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland.
⁶ Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Genoa, Italy.
⁷ Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
⁸ Paediatric Neurosurgery Unit, Division of Neurosurgery, Faculty of Health Sciences, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
⁹ Department of Intensive Care, Clinique Universitaire de Bruxelles (CUB) Erasme, Brussels, Belgium.
¹⁰ School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.

PMID: 30019201
DOI: 10.1007/s00134-018-5305-7

Abstract

Purpose: Although invasive intracranial devices (IIDs) are the gold standard for intracranial pressure (ICP) measurement, ultrasonography of the optic nerve sheath diameter (ONSD) has been suggested as a potential non-invasive ICP estimator. We performed a meta-analysis to evaluate the diagnostic accuracy of sonographic ONSD measurement for assessment of intracranial hypertension (IH) in adult patients.

Methods: We searched on electronic databases (MEDLINE/PubMed^®, Scopus^®, Web of Science^®, ScienceDirect^®, Cochrane Library^®) until 31 May 2018 for comparative studies that evaluated the efficacy of sonographic ONSD vs. ICP measurement with IID. Data were extracted independently by two authors. We used the QUADAS-2 tool for assessing the risk of bias (RB) of each study. A diagnostic meta-analysis following the bivariate approach and random-effects model was performed.

Results: Seven prospective studies (320 patients) were evaluated for IH detection (assumed with ICP > 20 mmHg or > 25 cmH₂O). The accuracy of included studies ranged from 0.811 (95% CI 0.678‒0.847) to 0.954 (95% CI 0.853‒0.983). Three studies were at high RB. No significant heterogeneity was found for the diagnostic odds ratio (DOR), positive likelihood ratio (PLR) and negative likelihood ratio (NLR), with I² < 50% for each parameter. The pooled DOR, PLR and NLR were 67.5 (95% CI 29‒135), 5.35 (95% CI 3.76‒7.53) and 0.088 (95% CI 0.046‒0.152), respectively. The area under the hierarchical summary receiver-operating characteristic curve (AUHSROC) was 0.938. In the subset of five studies (275 patients) with IH defined for ICP > 20 mmHg, the pooled DOR, PLR and NLR were 68.10 (95% CI 26.8‒144), 5.18 (95% CI 3.59‒7.37) and 0.087 (95% CI 0.041‒0.158), respectively, while the AUHSROC was 0.932.

Conclusions: Although the wide 95% CI in our pooled DOR suggests caution, ultrasonographic ONSD may be a potentially useful approach for assessing IH when IIDs are not indicated or available (CRD42018089137, PROSPERO).

Keywords: Adult patients; Intracranial pressure; Invasive intracranial devices; Meta-analysis; Optic nerve sheath diameter; Ultrasonography.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Humans
Intracranial Hypertension* / diagnostic imaging
Intracranial Pressure*
Optic Nerve* / anatomy & histology
Optic Nerve* / diagnostic imaging
Prospective Studies
Sensitivity and Specificity
Ultrasonography