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

Research output: Contribution to journalReview article

23 Citations (Scopus)

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).

Original languageEnglish
Pages (from-to)1284-1294
Number of pages11
JournalIntensive Care Medicine
Volume44
Issue number8
DOIs
Publication statusPublished - Aug 1 2018

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Intracranial Pressure
Optic Nerve
Intracranial Hypertension
Meta-Analysis
Odds Ratio
Equipment and Supplies
PubMed
MEDLINE
Libraries
Ultrasonography
Databases
Prospective Studies

Keywords

  • Adult patients
  • Intracranial pressure
  • Invasive intracranial devices
  • Meta-analysis
  • Optic nerve sheath diameter
  • Ultrasonography

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure : a systematic review and meta-analysis. / Robba, Chiara; Santori, Gregorio; Czosnyka, Marek; Corradi, Francesco; Bragazzi, Nicola; Padayachy, Llewellyn; Taccone, Fabio Silvio; Citerio, Giuseppe.

In: Intensive Care Medicine, Vol. 44, No. 8, 01.08.2018, p. 1284-1294.

Research output: Contribution to journalReview article

Robba, Chiara ; Santori, Gregorio ; Czosnyka, Marek ; Corradi, Francesco ; Bragazzi, Nicola ; Padayachy, Llewellyn ; Taccone, Fabio Silvio ; Citerio, Giuseppe. / Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure : a systematic review and meta-analysis. In: Intensive Care Medicine. 2018 ; Vol. 44, No. 8. pp. 1284-1294.
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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{\circledR}, Scopus{\circledR}, Web of Science{\circledR}, ScienceDirect{\circledR}, Cochrane Library{\circledR}) 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",
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T1 - Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure

T2 - a systematic review and meta-analysis

AU - Robba, Chiara

AU - Santori, Gregorio

AU - Czosnyka, Marek

AU - Corradi, Francesco

AU - Bragazzi, Nicola

AU - Padayachy, Llewellyn

AU - Taccone, Fabio Silvio

AU - Citerio, Giuseppe

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Y1 - 2018/8/1

N2 - 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).

AB - 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).

KW - Adult patients

KW - Intracranial pressure

KW - Invasive intracranial devices

KW - Meta-analysis

KW - Optic nerve sheath diameter

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