Optic Nerve Sheath Diameter Sonography for the Diagnosis of Increased Intracranial Pressure in Nontraumatic Neurocritically Ill Patients: a Diagnostic Accuracy Systematic Review and Meta-Analysis.

IF 3.6 3区医学 Q2 CLINICAL NEUROLOGY

Neurocritical Care Pub Date : 2025-10-01 Epub Date: 2025-04-01 DOI:10.1007/s12028-025-02249-6

Rafael Hortêncio Melo, Luciana Gioli-Pereira, Fábio Santana Machado, Chiara Robba

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引用次数: 0

Abstract

Background: Optic nerve sheath diameter (ONSD) assessed by ultrasound is a feasible bedside method for increased intracranial pressure (IICP) diagnosis. However, most of the evidence relies on the population of patients with traumatic brain injury, with few data available on other populations. Consequently, its efficacy in nontraumatic critically ill patients remains underexplored. Our purpose was to examine the accuracy of ONSD ultrasonography for diagnosing IICP in nontraumatic neurocritically ill patients.

Methods: We conducted a systematic search of PubMed, Embase, and the Cochrane Library databases for comparative studies of adult nontraumatic critically ill patients that evaluated the accuracy of sonographic ONSD for IICP diagnosis compared with invasive or noninvasive reference standards. Two reviewers independently completed the search, data abstraction, and quality assessment with Quality Assessment of Diagnostic Accuracy Studies-2 tool. Heterogeneity was examined with I² statistics. We used a bivariate model of random effects to summarize pooled diagnostic odds ratio, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and summary receiver operating characteristic.

Results: We included 18 observational studies, comprising 1,484 patients. Etiology of IICP was mixed, being composed of central nervous system infection, intracranial hemorrhage, acute ischemic stroke, aneurysmal subarachnoid hemorrhage, idiopathic intracranial hypertension, and hypoxic-ischemic brain injury. The pooled diagnostic odds ratio was 44.7 (95% confidence interval [CI] 22.5-80.1). Pooled sensitivity and specificity were 0.92 (95% CI 0.85-0.95) and 0.90 (95% CI 0.84-0.94), respectively, with a positive likelihood ratio of 6.19 (95% CI 4.4-8.5), and a negative likelihood ratio of 0.148 (95% CI 0.09-0.22). Summary receiver operating characteristic showed a calculated area under the curve of 0.925 (95% CI 0.84-0.927). Subgroup analysis of invasive and noninvasive reference standards showed similar accuracy of ultrasound ONSD for IICP diagnosis.

Conclusions: Ultrasound ONSD may be a potentially useful noninvansive tool for IICP diagnosis in patients with nontraumatic brain injury.

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视神经鞘直径超声诊断非外伤性神经危重症患者颅内压增高：诊断准确性系统评价和meta分析。

背景：超声评估视神经鞘直径（ONSD）是诊断颅内压增高（IICP）的一种可行的床边方法。然而，大多数证据依赖于创伤性脑损伤患者群体，很少有其他人群的数据。因此，它对非创伤性危重病人的疗效仍未得到充分探讨。我们的目的是检查ONSD超声诊断非创伤性神经危重症患者IICP的准确性。方法：我们对PubMed、Embase和Cochrane图书馆的成人非创伤性危重患者进行了系统的检索，以比较超声ONSD与有创或无创参考标准诊断IICP的准确性。两名审稿人独立完成检索、数据提取和使用诊断准确性研究质量评估-2工具进行质量评估。用I2统计量检验异质性。我们使用随机效应的双变量模型来总结合并诊断的优势比、敏感性、特异性、阳性似然比、阴性似然比和总的受者工作特征。结果：我们纳入了18项观察性研究，共1484例患者。IICP病因复杂，包括中枢神经系统感染、颅内出血、急性缺血性脑卒中、动脉瘤性蛛网膜下腔出血、特发性颅内高压、缺氧缺血性脑损伤。合并诊断优势比为44.7（95%可信区间[CI] 22.5-80.1）。合并敏感性和特异性分别为0.92 （95% CI 0.85-0.95）和0.90 (95% CI 0.84-0.94)，阳性似然比为6.19 (95% CI 4.4-8.5)，阴性似然比为0.148 （95% CI 0.09-0.22）。总体受试者工作特征曲线下计算面积为0.925 （95% CI 0.84-0.927）。有创和无创参考标准的亚组分析显示超声ONSD诊断IICP的准确性相似。结论：超声ONSD可能是一种潜在有用的非创伤性脑损伤患者IICP诊断的无创工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurocritical Care 医学-临床神经学

CiteScore

7.40

自引率

8.60%

发文量

221

审稿时长

4-8 weeks

期刊介绍： Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.