الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Elevated ICP is a common complication of TBI that requires rapid diagnosis
and therapeutic intervention. Invasive ICP monitoring is the gold standard for
demonstrating ICP increase but can lead to complications such as hemorrhage and
bacterial colonization. In addition, it is not always possible owing to a patient
contraindication or ICP monitoring availability issues.
Therefore, noninvasive methods have been developed for detection of high
ICP. At the moment, brain CT scan is considered as the noninvasive method of
choice in this regard, but important disadvantages such as the need for patient
transportation, being time-consuming, and excessive radiation hazards have urged
researchers to find other alternatives.
An ideal situation for diagnosis of elevated ICP would be a technique that is
rapid, reliable, accessible, easy to learn, noninvasive, and inexpensive. Ultrasound
technology lends itself well to these situations and is commonly used in the
evaluation of trauma patients.
The optic nerve is a tubular structure of about 5 cm in length in which its intraorbital
segment is evaluable sonographically. Histologically it is surrounded by the
same meningeal layers as the brain including a subarachnoid space which may
experiences the same pressure changes as the intracranial compartment.
In this study, we prospectively evaluated the diagnostic accuracy of ONSD
sonography for detecting elevated ICP in adult patients with TBI in the ED.Our study was carried out on a total of 80 patients of both sexes, who had TBI
and were referred to brain CT scanning in a duration of one year from April 2017 to
April 2018. They were selected from those presented to the ED of Tanta University
Hospitals.
All patients included in the study were subjected to: full history taking,
general and neurological examination, brain CT scan, and ONSD measurement by
ultrasound. Based on the CT findings of increased ICP, patients were divided into
two groups: group A which included 40 patients who had findings of increased
ICP and group B that included 40 patients who had no findings of increased ICP
on CT brain.
The most common mechanism of injury in our patients was MVCs (60% and
55% in group A and B respectively). Other mechanisms of injury were also
represented, including falls (20% and 25%), blunt assaults (10% and 5%), struck
by/against injuries (5% and 5%), penetrating injuries (2.5% and 10%), and sportsrelated
injuries (2.5% and 0%) in group A and B respectively. Regarding clinical
features of raised ICP, our study revealed that it has a low sensitivity and
specificity for diagnosis of increased ICP (30% and 72.5 % respectively).
As regard ONSD measurement in the present study, mean ONSD was
significantly higher in patients with increased ICP (group B) compared with
patients with normal ICP (group A). The mean ONSD ranged from 2.48 to 5.76
mm with a mean value of 4.047 mm in patients of group A while in patients of
group B, ONSD ranged from 5.25 to 7.72 mm with a mean value of 6.493 mm.
The cutoff value of ONSD for diagnosing increased ICP was >4.95 mm with
sensitivity of 100.0 %, specificity of 95 %, PPV of 95.2%, NPV of 100% and
accuracy of 99.6%.