Abstract
ObjectivesUltrasound measurement of the optic nerve sheath diameter (ONSD) is a rapid, non-invasive means to indirectly assess intracranial pressure. Previous research has demonstrated the ability of emergency physicians to measure ONSD accurately with bedside ultrasound when compared to CT scan or MRI, however the reliability of this measurement between two or more operators has been called into question (Hassen et al. in J Emerg Med 48:450–457, 2015; Shirodkar et al. in Ind J Crit Care Med 19:466–470, 2015). Given the need for accurate and precise measurement to use this as a screening exam, we sought to determine the inter-rater reliability between ONSD measurements obtained in real time by fellowship-trained emergency ultrasound physicians.MethodsThree ultrasound fellowship-trained emergency physicians measured bilateral ONSD of 10 healthy volunteers using a high-frequency linear transducer. The physicians were blinded to the other scanners’ measurements, and no instructions were given other than to obtain the ONSD. Each sonographer measured the ONSD in real time and it was recorded by a research coordinator. All measurements were recorded in millimeters. Intraclass correlation coefficients (ICCs) were calculated to estimate the inter-rater reliability.ResultsA total of 60 measurements of ONSD were obtained. The average measurement was 4.3 mm (3.83–4.77). Very little variation was found between the three physicians, with a calculated ICC of 0.82 (95% confidence interval 0.63–0.92).ConclusionsONSD measurement obtained by ultrasound fellowship-trained emergency medicine physicians is a reliable measurement with a high degree of correlation between scanners.
Highlights
The recent spread of ultrasound technology and its adaptation at the bedside by emergency physicians has led to the exploration of a wide number of potential clinical applications [3]
While multiple prior studies have detailed the correlation between increased optic nerve sheath diameter (ONSD) and elevated ICP, no studies to our knowledge have assessed the ability of emergency physicians to obtain reliable measurements in real time
We assessed the ability of three ultrasound fellowship-trained emergency physicians to obtain measurements of ONSD independently and in real time on healthy volunteers
Summary
The recent spread of ultrasound technology and its adaptation at the bedside by emergency physicians has led to the exploration of a wide number of potential clinical applications [3]. Ocular ultrasonography is a relatively new application in emergency medicine. Jennings et al The Ultrasound Journal (2022) 14:6 be limited by severe facial and head trauma. Emergency department ultrasound provides a quick, accurate, well-tolerated and non-invasive tool for evaluating potentially vision-threatening and life-threatening conditions at the bedside [5]. Elevated intracranial pressure is a potentially devastating condition. Rapid detection and subsequent management of elevated intracranial pressure is critical as increased intracranial pressure is associated with increased morbidity, mortality and poor neurologic outcome. The gold standard for measurement of intracranial pressure is invasive and fraught with risk, requiring placement of intraventricular catheters and/or intraparenchymal probes [6]
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