Noninvasive Assessment of Intracranial Pressure: Deformability Index as an Adjunct to Optic Nerve Sheath Diameter to Increase Diagnostic Ability

被引:6
作者
Netteland, Dag Ferner [1 ,2 ]
Aarhus, Mads [1 ]
Sandset, Else Charlotte [3 ,4 ]
Padayachy, Llewellyn [5 ,6 ]
Helseth, Eirik [1 ,2 ]
Brekken, Reidar [7 ]
机构
[1] Oslo Univ Hosp, Dept Neurosurg, Pb 4956 Nydalen, N-0424 Oslo, Norway
[2] Univ Oslo, Fac Med, Oslo, Norway
[3] Oslo Univ Hosp, Dept Neurol, Oslo, Norway
[4] Norwegian Air Ambulance Fdn, Oslo, Norway
[5] Univ Pretoria, Dept Neuro Surg, Fac Hlth Sci, Sch Med, Pretoria, South Africa
[6] Steve Biko Acad Hosp, Pretoria, South Africa
[7] SINTEF, Dept Hlth Res Med Technol, Trondheim, Norway
关键词
Deformability index; Optic nerve sheath diameter; Ultrasound; Noninvasive; Intracranial pressure; Traumatic brain injury; HYPERTENSION;
D O I
10.1007/s12028-024-01955-x
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BackgroundToday, invasive intracranial pressure (ICP) measurement remains the standard, but its invasiveness limits availability. Here, we evaluate a novel ultrasound-based optic nerve sheath parameter called the deformability index (DI) and its ability to assess ICP noninvasively. Furthermore, we ask whether combining DI with optic nerve sheath diameter (ONSD), a more established parameter, results in increased diagnostic ability, as compared to using ONSD alone. MethodsWe prospectively included adult patients with traumatic brain injury with invasive ICP monitoring, which served as the reference measurement. Ultrasound images and videos of the optic nerve sheath were acquired. ONSD was measured at the bedside, whereas DI was calculated by semiautomated postprocessing of ultrasound videos. Correlations of ONSD and DI to ICP were explored, and a linear regression model combining ONSD and DI was compared to a linear regression model using ONSD alone. Ability of the noninvasive parameters to distinguish dichotomized ICP was evaluated using receiver operating characteristic curves, and a logistic regression model combining ONSD and DI was compared to a logistic regression model using ONSD alone. ResultsForty-four ultrasound examinations were performed in 26 patients. Both DI (R = - 0.28; 95% confidence interval [CI] R < - 0.03; p = 0.03) and ONSD (R = 0.45; 95% CI R > 0.23; p < 0.01) correlated with ICP. When including both parameters in a combined model, the estimated correlation coefficient increased (R = 0.51; 95% CI R > 0.30; p < 0.01), compared to using ONSD alone, but the model improvement did not reach statistical significance (p = 0.09). Both DI (area under the curve [AUC] 0.69, 95% CI 0.53-0.83) and ONSD (AUC 0.72, 95% CI 0.56-0.86) displayed ability to distinguish ICP dichotomized at ICP >= 15 mm Hg. When using both parameters in a combined model, AUC increased (0.80, 95% CI 0.63-0.90), and the model improvement was statistically significant (p = 0.02). ConclusionsCombining ONSD with DI holds the potential of increasing the ability of optic nerve sheath parameters in the noninvasive assessment of ICP, compared to using ONSD alone, and further study of DI is warranted.
引用
收藏
页码:479 / 488
页数:10
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