Optic nerve sheath diameter measurement for predicting raised intracranial pressure in adult patients with severe traumatic brain injury: A meta-analysis

J Crit Care. 2020 Apr;56:182-187. doi: 10.1016/j.jcrc.2020.01.006. Epub 2020 Jan 8.


Objective: To evaluate and compare the diagnostic feasibility of measuring the optic nerve sheath diameter (ONSD), via brain computed tomography (CT) and ocular ultrasonography (US) for prediction of raised intracranial pressure (ICP) in severe traumatic brain injury (TBI) patients.

Methods: The PubMed and EMBASE databases were searched for studies assessing the diagnostic accuracy of brain CT or ocular US for predicting raised ICP. Bivariate and hierarchical summary receiver operating characteristic modeling were performed to evaluate and compare the diagnostic feasibility of measuring the ONSD in adult patients with severe TBI according to modality (ocular US vs. brain CT).

Results: Five studies (four with ocular US and one with brain CT) were included. The ONSD had a pooled sensitivity of 0.91, pooled specificity of 0.77, and area under the HSROC curve of 0.92 for predicting raised ICP. More importantly, studies using ocular US found an almost equal sensitivity (0.91 vs. 0.90; p = .35) and higher specificity (0.82 vs. 0.58; p = .01) than those using brain CT.

Conclusions: Measurement of the ONSD may be a useful method for predicting raised ICP in adult patients with severe TBI.

Keywords: Crain computed tomography; Critical care; Head trauma; Intracranial pressure; Ocular ultrasound.

Publication types

  • Meta-Analysis

MeSH terms

  • Adult
  • Brain Injuries, Traumatic / complications
  • Brain Injuries, Traumatic / diagnostic imaging*
  • Female
  • Humans
  • Intracranial Hypertension / complications
  • Intracranial Hypertension / diagnostic imaging*
  • Intracranial Pressure*
  • Male
  • Optic Nerve / diagnostic imaging*
  • ROC Curve
  • Treatment Outcome
  • Ultrasonography