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Journal of Trauma and Injury 2013;26(3):104-110.
Availability of the Optic Nerve Sheath Diameter Measured by Using Ultrasonography as a Secondary Survey for Patient with Head Injuries in the Emergency Department
Dong Wook Lee, Jung Won Lee, Sae Hoon Park, Ihl Sung Park, Hyun Jung Lee, Byeong Dae Yoo, Hyung Jun Moon
1Department of Emergency Medicine, Soon Chun Hyang University College of Medicine, Cheonan, Korea. daybreakscent@gmail.com
2Department of Emergency Medicine, Soon Chun Hyang University College of Medicine, Gumi, Korea.
응급실에 내원한 두부외상환자의 2차 평가로써 초음파를 이용한 시각신경집 지름 측정은 유용한가?
이동욱, 이정원, 박세훈, 박일성, 이현정, 유병대1, 문형준
순천향대학교 천안병원 응급의학교실, 1순천향대학교 구미병원 응급의학교실
Received: 19 July 2013   • Revised: 24 August 2013   • Accepted: 28 August 2013
Abstract
PURPOSE
Bedside ultrasonography is available in most emergency departments, and detecting the intracranial pressure is elevated is critical. Our objective is to evaluate the availability of bedside optic nerve ultrasound (ONUS) as a secondary survey for patients with head injuries in the emergency department (ED).
METHODS
From September, 2012, to March, 2013, we performed a prospective study of patients presenting to the ED after an accident. Patients with head injuries but without obvious ocular trauma or ocular disease were included. The ONUS was performed using a 3 to 12 MHz linear probe on closed eyelids after a primary survey. We analyzed the correlation between the brain computed tomography (CT) findings that suggested elevated intracranial pressure (ICP) and the Optic nerve sheath diameter (ONSD) measured by using ONUS.
RESULTS
A total of 81 patients were enrolled. Forty-seven had CT results consistent with elevated ICP, and their mean ONSD was 5.98+/-0.59 mm; the mean ONSD of patients who showed no signs of elevated ICP on CT was 4.63+/-0.21 mm. The sensitivity and the specificity for the ONSD, compared with elevated ICP, were 98.87% and 100%, respectively, when the cut-off value was set to 4.96 mm. The area under curve (AUC) was 0.997 in the receiver operating characteristic curve (ROC curve).
CONCLUSION
An evaluation using ONUS is a simple noninvasive procedure and is a potentially useful tool as a secondary survey to identify an elevated ICP.
Key Words: Head injuries; Optic nerve; Ultrasonography; Intracranial pressure


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