Association Between Optic Nerve Sheath Diameter and Mortality in Patients with Severe Traumatic Brain Injury
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ORIGINAL ARTICLE
Association Between Optic Nerve Sheath Diameter and Mortality in Patients with Severe Traumatic Brain Injury Mypinder S. Sekhon • Paul McBeth • Jie Zou • Lu Qiao • Leif Kolmodin • William R. Henderson Steve Reynolds • Donald E. G. Griesdale
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Ó Springer Science+Business Media New York 2014
Abstract Purpose Increased intracranial pressure (ICP) is associated with worse outcomes following traumatic brain injury (TBI). Studies have confirmed that ICP is correlated with optic nerve sheath diameter (ONSD) on ultrasound. The aim of our study was to assess the independent relationship between ONSD measured using CT and mortality in a population of patients admitted with severe TBI. Methods We conducted a retrospective cohort study of patients with a TBI requiring ICP monitoring admitted to the ICU between April 2006 and May 2012 to two neurotrauma centers. ONSD was independently measured by two physicians blinded to patient outcomes. Multivariable logistic regression modeling was used to assess an association between ONSD and hospital mortality. M. S. Sekhon (&) P. McBeth J. Zou L. Qiao L. Kolmodin W. R. Henderson D. E. G. Griesdale Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, BC V5Z 1M9, Canada e-mail: [email protected] S. Reynolds Department of Critical Care Medicine, Royal Columbian Hospital, University of British Columbia, New Westminster, BC, Canada D. E. G. Griesdale Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, West 12th Avenue, Vancouver, BC V5Z 1M9, Canada D. E. G. Griesdale Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, 899 West 12th Avenue, Vancouver, BC V5Z 1M9, Canada
Results A total of 220 patients were included in the analysis. Overall, the cohort had a mean age of 35 (SD 17) years and 171 of 220 (79 %) were male. The median admission GCS was 6 (IQR 3–8). Intra-class correlation coefficient between raters for ONSD measurements was 0.92 (95 % CI 0.90–0.94, P < 0.0001). On multivariable analysis, each 1 mm increase in ONSD was associated with a twofold increase in hospital mortality (OR 2.0, 95 % CI 1.2–3.2, P = 0.007). Using linear regression, ONSD was independently associated with increased ICP in the first 48 h after admission (b = 4.4, 95 % CI 2.5–6.3, P < 0.0001). Conclusions In patients with TBI, ONSD measured on CT scanning was independently associated with ICP and mortality. Keywords Optic nerve sheath diameter Computed tomography Traumatic brain injury Intracranial pressure Cerebral spinal fluid
Introduction The burden of traumatic brain injury (TBI) on an individual and societal level is substantial. Each year in the United States, 1.4 million patients suffer a TBI. Of these, 235,000 patients are hospitalized, and 50,000 die [1]. Importantly, less t
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