Original articleRole of serial ultrasonic optic nerve sheath diameter monitoring in head injury
Introduction
Orbital ultrasound to measure optic nerve sheath diameter (ONSD) is an innovative procedure which is useful to detect increased intracranial pressure (ICP) [1], [2], [3], [4], [5]. It is also a non-invasive method and a very useful technique to monitor the ICP in head injury patients. As this technique is not as accurate as invasive ICP monitoring, serial recordings might be more useful than depending only on a single value. The ONSD measurements of head injury patients were in fact, compared to healthy subjects. We also investigated the significance of serial ONSD monitoring in head injury patients.
Section snippets
Methods
This prospective study was carried out in Department of Neurosurgery over a period of 21 months from September 2013 to May 2015. All patients with a head injury admitted in our hospital with a program of conservative management at the time of admission were included in the study. Head injury patients with no parenchymal injury, ocular trauma or requiring polytrauma management were excluded from the study. On admission the patient was assessed based on a Glasgow Coma Scale (GCS), ultrasound
Results
The mean right-left ONSD of patients and healthy subjects, 4.8 mm and 3.4 mm respectively, were different (P < 0.0001) (Table 1). Out of 40 patients, there were 18 mild, 17 moderate and 5 severe head injury patients. The mean ONSD values of the mild, moderate and severe head injury patients were 4.4, 4.9 and 5.7 mm, respectively (Table 1).
The statistical correlation between GCS, ONSD and radiological scores in the case group are shown in Table 2. Average right-left ONSD was higher for lower GCS (P =
Discussion
Orbital ultrasound to detect ONSD is becoming increasingly popular as an adjuvant modality of neuro-imaging tools in the neurology ICU. Although it has some limitations, it is non-invasive, safe, easily reproducible, repetitive, and a cost-effective examination when compared to invasive intracranial pressure monitoring. It is efficient and the examination takes approximately 5 minutes per patient [8]. In head injury patients, associated orbital trauma with optic nerve injury the application of
Conclusions
The results of our study suggest that orbital ultrasound to measure ONSD can be a useful adjunct to making clinical decisions and CT scan findings in a setting, where invasive ICP monitoring is not available. Serial recordings of ONSD is thus a valuable tool and offers important and basic information regarding decision making. Normal ONSD values should be recorded in each institute in order to define the normal range.
Financial support
Institutional.
Disclosure of interest
The authors declare that they have no competing interest.
Acknowledgement
The authors are grateful to Mrs. Naga Saritha Kolli, lecturer in Statistics at NRI Academy of Sciences, Chinakakani for her help regarding the statistical analysis of the study.
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