Alex Koziarz, MSc; Niv Sne, MD; Fraser Kegel, BSc; Siddharth Nath, BSc; Jetan H. Badhiwala, MD; Farshad Nassiri, MD; Alireza Mansouri, MD; Kaiyun Yang, MD; Qi Zhou, PhD; Timothy Rice, MD; Samir Faidi, MD; Edward Passos, MD; Andrew Healey, MD; Laura Banfield, MLIS; Mark Mensour, MD; Andrew W. Kirkpatrick, MD; Aussama Nassar, MD; Michael G. Fehlings, MD; Gregory W.J. Hawryluk, MD; Saleh A. Almenawer, MD
Disclosures: Dr. Kirkpatrick reports a grant from Acelity Corporation and personal fees from Innovative Trauma Care Corporation outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0812.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: PROSPERO, CRD42017055485. Statistical code and data set: See the Supplement.
Corresponding Author: Saleh A. Almenawer, MD, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Mr. Koziarz: University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.
Drs. Sne, Yang, Zhou, Rice, Faidi, Passos, Healey, and Almenawer: McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada.
Mr. Kegel: McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec H3G 1Y6, Canada.
Mr. Nath: School of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada.
Drs. Badhiwala, Nassiri, Mansouri, and Fehlings: University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada.
Ms. Banfield: Health Sciences Library, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
Dr. Mensour: Northern School of Medicine, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada.
Dr. Kirkpatrick: University of Calgary, 2500 University Drive Northwest, Calgary, Alberta T2N 1N4, Canada.
Dr. Nassar: Stanford University, 300 Pasteur Drive, Stanford, CA 94305.
Dr. Hawryluk: University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT 84132.
Author Contributions: Conception and design: A. Koziarz, N. Sne, F. Kegel, S. Faidi, S.A. Almenawer.
Analysis and interpretation of the data: A. Koziarz, N. Sne, F. Kegel, S. Faidi, L. Banfield, S.A. Almenawer.
Drafting of the article: A. Koziarz, S.A. Almenawer.
Critical revision of the article for important intellectual content: A. Koziarz, N. Sne, F. Kegel, S. Nath, J.H. Badhiwala, F. Nassiri, A. Mansouri, K. Yang, Q. Zhou, T. Rice, S. Faidi, E. Passos, A. Healey, L. Banfield, M. Mensour, A.W. Kirkpatrick, A. Nassar, M.G. Fehlings, G.W.J. Hawryluk, S.A. Almenawer.
Final approval of the article: A. Koziarz, N. Sne, F. Kegel, S. Nath, J.H. Badhiwala, F. Nassiri, A. Mansouri, K. Yang, Q. Zhou, T. Rice, S. Faidi, E. Passos, A. Healey, L. Banfield, M. Mensour, A.W. Kirkpatrick, A. Nassar, M.G. Fehlings, G.W.J. Hawryluk, S.A. Almenawer.
Provision of study materials or patients: S.A. Almenawer.
Statistical expertise: A. Koziarz, Q. Zhou, and S.A. Almenawer.
Administrative, technical, or logistic support: S.A. Almenawer.
Collection and assembly of data: A. Koziarz, N. Sne, F. Kegel, S.A. Almenawer.
Optic nerve ultrasonography (optic nerve sheath diameter sonography) has been proposed as a noninvasive, quick method for diagnosing increased intracranial pressure.
To examine the accuracy of optic nerve ultrasonography for diagnosing increased intracranial pressure in children and adults.
13 databases from inception through May 2019, reference lists, and meeting proceedings.
Prospective optic nerve ultrasonography diagnostic accuracy studies, published in any language, involving any age group or reference standard.
3 reviewers independently abstracted data and performed quality assessment.
Of 71 eligible studies involving 4551 patients, 61 included adults, and 35 were rated as having low risk of bias. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of optic nerve ultrasonography in patients with traumatic brain injury were 97% (95% CI, 92% to 99%), 86% (CI, 74% to 93%), 6.93 (CI, 3.55 to 13.54), and 0.04 (CI, 0.02 to 0.10), respectively. Respective estimates in patients with nontraumatic brain injury were 92% (CI, 86% to 96%), 86% (CI, 77% to 92%), 6.39 (CI, 3.77 to 10.84), and 0.09 (CI, 0.05 to 0.17). Accuracy estimates were similar among studies stratified by patient age, operator specialty and training level, reference standard, sonographer blinding status, and cutoff value. The optimal cutoff for optic nerve sheath dilatation on ultrasonography was 5.0 mm.
Small studies, imprecise summary estimates, possible publication bias, and no evaluation of effect on clinical outcomes.
Optic nerve ultrasonography can help diagnose increased intracranial pressure. A normal sheath diameter measurement has high sensitivity and a low negative likelihood ratio that may rule out increased intracranial pressure, whereas an elevated measurement, characterized by a high specificity and positive likelihood ratio, may indicate increased intracranial pressure and the need for additional confirmatory tests.
None. (PROSPERO: CRD42017055485)
Koziarz A, Sne N, Kegel F, et al. Bedside Optic Nerve Ultrasonography for Diagnosing Increased Intracranial Pressure: A Systematic Review and Meta-analysis. Ann Intern Med. 2019;:. [Epub ahead of print 19 November 2019]. doi: https://doi.org/10.7326/M19-0812
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Published: Ann Intern Med. 2019.
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