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The role of optic nerve sheath ultrasonography in increased intracranial pressure: a systematic review and meta analysis

2023Journal article Open access
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dc.contributor.authorBerhanu, David
dc.contributor.authorCardoso Ferreira, Joana
dc.contributor.authorPinto, Luis
dc.contributor.authorde Sousa, Diana Aguiar
dc.contributor.authorLucas Neto, Lia
dc.contributor.authorTavares Ferreira, Joana
dc.date.accessioned2024-01-10T11:59:47Z
dc.date.available2024-01-10T11:59:47Z
dc.date.issued2023
dc.description© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).pt_PT
dc.description.abstractObjectives: To review the optimal diagnostic cut-off of ultrasonographic optic nerve sheath diameter (ONSD) in the diagnosis of increased intracranial pressure (IICP). Methods: A systematic search was conducted of available studies assessing the use of ONSD ultrasonography in patients with suspected IICP. Meta-analysis of diagnostic accuracy of ultrasonographic ONSD was performed using a bivariate model of random effects to summarize pooled sensitivity and specificity. A summary receiver operating characteristics (SROC) curve was plotted. Accuracy measures associated with ONSD cut-off and predefined covariates were investigated with meta-regression. Results: We included 38 studies, comprising a total of 2824 patients. A total of 21 studies used invasive techniques as a reference standard estimation of IICP and meta-analysis revealed a pooled sensitivity of 0.90 (95% CI 0.85-0.93) and specificity of 0.87 (95% CI 0.80-0.91). Optimal ONSD cut-off values ranged between 4.1 mm and 7.2 mm. Meta-regression analysis showed that ONSD cut-off values of 5.6 to 6.3 mm were associated with higher pooled specificity compared to cut-off values of 4.9 to 5.5 mm (0.93, 95% CI 0.85-0.97 vs. 0.78, 95% CI 0.65-0.87; p = 0.036). Conclusions: Ultrasonography of ONSD shows a high diagnostic accuracy for IICP, with high pooled sensitivity and specificity. Additionally, larger cut-off values seem to significantly increase specificity without compromising sensitivity, which support their use as optimal ONSD cut-off. The overall high sensitivity of ultrasonographic ONSD suggests its usefulness as a screening tool for IIC, which may provide an estimate of when invasive methods are warranted. Clinical relevance: ONSD ultrasonography is a fast and cost-effective method with a high diagnostic accuracy to detect IICP. The optimum ONSD cut-off hasn't been established before, but we suggest the 5.6 to 6.3 mm range as the best for the diagnosis of IICP.pt_PT
dc.description.sponsorshipDB has received funding from the Portuguese Foundation for Science and Technology [Fundação para a Ciência e Tecnologia – reference 2022.10667.BD] and Santa Casa da Misericórdia de Lisboa [Prémio João Lobo Antunes 2022].pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Neurol Sci. 2023 Nov 15:454:120853pt_PT
dc.identifier.doi10.1016/j.jns.2023.120853pt_PT
dc.identifier.eissn1878-5883
dc.identifier.issn0022-510X
dc.identifier.urihttp://hdl.handle.net/10451/61686
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relationOptic Nerve Anatomy and Imaging – A Surrogate for Intracranial Pressure
dc.relation.publisherversionhttps://www.sciencedirect.com/journal/journal-of-the-neurological-sciencespt_PT
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/pt_PT
dc.subjectIntracranial pressurept_PT
dc.subjectOptic nerve sheathpt_PT
dc.subjectOptic nerve sheath diameterpt_PT
dc.subjectUltrasonographypt_PT
dc.titleThe role of optic nerve sheath ultrasonography in increased intracranial pressure: a systematic review and meta analysispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.awardTitleOptic Nerve Anatomy and Imaging – A Surrogate for Intracranial Pressure
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/OE/2022.10667.BD/PT
oaire.citation.titleJournal of the Neurological Sciencespt_PT
oaire.citation.volume454pt_PT
oaire.fundingStreamOE
person.familyNameAlves Berhanu
person.familyNameCardoso Ferreira
person.familyNameAbegão Pinto
person.familyNameAguiar de Sousa
person.familyNameLucas Neto
person.familyNameTAVARES FERREIRA
person.givenNameDavid
person.givenNameJoana
person.givenNameLuis
person.givenNameDiana
person.givenNameLia
person.givenNameJOANA PATRÍCIA
person.identifier574112
person.identifier.ciencia-idB912-8429-153C
person.identifier.ciencia-idF216-4AFA-8E65
person.identifier.ciencia-id571C-121A-5CCB
person.identifier.ciencia-id6911-9043-B80D
person.identifier.ciencia-idBE17-CE78-71F4
person.identifier.orcid0000-0003-1851-7182
person.identifier.orcid0009-0000-2185-0205
person.identifier.orcid0000-0002-9960-7579
person.identifier.orcid0000-0002-6702-7924
person.identifier.orcid0000-0001-7880-9625
person.identifier.orcid0000-0002-2237-3962
person.identifier.ridJ-4105-2013
person.identifier.scopus-author-id57192198642
person.identifier.scopus-author-id55781226000
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
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