학술논문
The incidence of increased ICP in ICU patients with non-traumatic coma as diagnosed by ONSD and CT: a prospective cohort study.
Document Type
Article
Author
Source
Subject
*CATASTROPHIC illness
*CEREBRAL edema
*COMA
*COMPUTED tomography
*CONFIDENCE intervals
*STATISTICAL correlation
*INTENSIVE care units
*INTRACRANIAL pressure
*LONGITUDINAL method
*OPTIC nerve
*PROBABILITY theory
*STATISTICS
*SAMPLE size (Statistics)
*DATA analysis
*RECEIVER operating characteristic curves
*DATA analysis software
*ODDS ratio
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Language
ISSN
1471-2253
Abstract
Background: Unexplained coma after critical illness can be multifactorial. We evaluated the diagnostic ability of bedside Optic Nerve Sheath Diameter [ONSD] as a screening test for non-traumatic radiographic cerebral edema. Methods: In a prospective study, mixed medical-surgical intensive care units [ICU] patients with non-traumatic coma [GCS < 9] underwent bedside ultrasonographic ONSD measurements. Non-traumatic radiographic cerebral edema [NTRCE] was defined as > 5 mm midline shift, cisternal, sulcal effacement, or hydrocephalus on CT. Results: NTRCE was identified in 31 of 102 patients [30.4 %]. The area under the ROC curve for detecting radiographic edema by ONSD was 0.785 [95 % CI 0.695-0.874, p <0.001]. ONSD diameter of 0.57 cm was found to be the best cutoff threshold with a sensitivity 84 % and specificity 71 %, AUC 0.785 [95 % CI 0.695-0.874, p <0.001]. Using ONSD as a bedside test increased the post-test odds ratio [OR] for NTRCE by 2.89 times [positive likelihood ratio], whereas post-test OR for NTRCE decreased markedly given a negative ONSD test [ONSD measurement less than 0.57 cm]; negative likelihood ratio 0.22. Conclusions: The use of ONSD as a bedside test in patients with non-traumatic coma has diagnostic value in identifying patients with non-traumatic radiographic cerebral edema. [ABSTRACT FROM AUTHOR]