Optic nerve sheath diameter measurement using point-of-care ultrasound to assess intracranial pressure of adult patients with traumatic brain injury in resource-limited setting

Abstract

BackgroundTraumatic brain injury is a disease with high mortality partially from increased intracranial pressure including in the emergency department. Neuroimaging and intracranial pressure monitoring are limited in resource-limited settings. Optic nerve sheath diameter measurement to assess intracranial pressure indirectly using point-of-care ultrasound is appealing in diagnostics and decision-making. ObjectivesWe plan to evaluate the utility of point-of-care ultrasound of optic nerve sheath diameter and its role in traumatic brain injury patients. Materials and MethodsOptic nerve sheath diameter measurement was performed at presentation, postoperatively and 24 h later by trained residents. The procedure was repeated if any change in clinical status was observed. Clinical data and demographics were recorded and reviewed. ResultsA total of 50 patients were enrolled. Twenty-one patients underwent neurosurgical intervention. Three patients died in hospital. Eighteen patients had optic nerve sheath diameters less than 5 mm, 20 patients had optic nerve sheath diameter between 5 mm and 6 mm, and 12 patients had optic nerve sheath diameter > 6 mm. In 2 patients with changes in clinical condition, the repeat optic nerve sheath diameter assessment showed an increase in optic nerve sheath diameter. ConclusionDespite limitations, trained healthcare providers could assess and measure optic nerve sheath diameter. Longer training time and quality assurance are needed to appreciate the impact.