الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 69 |  |  |
| | | from | 69 | | |
Abstract
Elevated ICP is a common complication of TBI which must be diagnosed early and closely monitored. Therapeutic interventions should be done as early as possible. Invasive ICP monitoring is the gold standard method for ICP monitoring. However it is not always possible owing to lack of resources or patients’ contraindication. In addition it may lead to complications such as hemorrhage or bacterial colonization.
Therefore, other non-invasive methods for ICP monitoring have been developed. At the time being Head CT is considered as the non-invasive modality of choice in this regard but it has several disadvantages such as the need for patient’s transportation, radiation exposure and being time consuming which urged the researchers to find alternative methods.
The ideal method to monitor ICP would be a technique that is rapid, reliable, accessible, easy to learn and inexpensive. Ultrasound technology lends itself well to these situations and is now commonly used in the assessment of trauma patients.
The optic nerve is a tubular structure of about 5 cm in length. Histologically it is surrounded by the same meningeal layer surrounding the brain including the subarachnoid space which may experience the same pressure changes like the intracranial compartment. The intra-orbital segment of the optic nerve can be assessed with ultrasonography.
In this study we prospectively evaluated the correlation between head CT and ONSD during monitoring the resolution of brain edema in adult patients with TBI in the ED.
Our study was carried on a total of 50 adult patients suffering from brain edema after closed head injures recruited from Alexandria main university hospitals. All the enrolled patients were evaluated with head CT and then ONSD was assessed with ultrasonography. Follow up CT brain was done every 24 hours or whenever indicated till the resolution of brain edema and follow up ONSD measurements were taken 3 times daily and within 30 minutes after every CT scan. The measured outcome was correlation between CT findings of elevated ICP and ONSD measurement with ultrasound.
Results showed a strong correlation between CT finding of elevated ICP and ONSD. ONSD was a statistically significant tool to predict the CT findings with a very high area under the curve (AUC=0.952) (95%CI: 0.901-1.003, P< 0.001). It showed good sensitivity (94%) and good specificity (90%). Its positive predictive value was 90.4% while its negative predictive value was 93.7%. There was a significant correlation between the ONSD and the GCS of the enrolled patients on admission and after follow up till the resolution of brain edema (P < 0.005).
In conclusion, optic nerve sheath diameter has a strong correlation to the signs of elevated intracranial pressure on head CT scan in adult patients with traumatic brain injury and therefore might be used as a non-invasive method to monitor the intracranial pressure and brain edema resolution.
We recommend that ONSD might be used as a reliable noninvasive method to monitor the intracranial pressure and brain edema resolution in patients with traumatic brain injury. This noninvasive, readily available, rapid, simple and bedside monitoring modality can be useful in variety of clinical situations including centers without CT scan, intensive care unit, and in centers where invasive methods is limited or unavailable.