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

Summary 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 diagno...

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Vydané v:Intensive care medicine Ročník 44; číslo 8; s. 1284 - 1294
Hlavní autori: Robba, Chiara, Santori, Gregorio, Czosnyka, Marek, Corradi, Francesco, Bragazzi, Nicola, Padayachy, Llewellyn, Taccone, Fabio Silvio, Citerio, Giuseppe
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2018
Springer
Springer Nature B.V
Predmet:
Adult
Anesthesiology
Bivariate analysis
Comparative analysis
Critical Care Medicine
Diagnostic systems
Emergency Medicine
Evidence-based medicine
Humans
Hypertension
Intensive
Intensive care
Intracranial Hypertension - diagnostic imaging
Intracranial Pressure
Likelihood ratio
Measurement
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Meta-analysis
Optic nerve
Optic Nerve - anatomy & histology
Optic Nerve - diagnostic imaging
Pain Medicine
Patients
Pediatrics
Pneumology/Respiratory System
Prospective Studies
Sensitivity and Specificity
Sheaths
Systematic Review
Ultrasonography
Ultrasound
Ultrasound imaging
United Kingdom
Intracranial pressure
Adult patients
Invasive intracranial devices
Ultrasonography
Optic nerve sheath diameter
Meta-analysis
ISSN:0342-4642, 1432-1238, 1432-1238
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Shrnutí:Summary 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 cmH 2 O). 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 I 2  < 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).
Bibliografia:ObjectType-Article-1
ObjectType-Evidence Based Healthcare-3
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:0342-4642
1432-1238
1432-1238
DOI:10.1007/s00134-018-5305-7