TY - JOUR
T1 - Optic nerve and transcranial doppler ultrasonography for diagnosing increased intracranial pressure in adult traumatic brain injury pa-tients
T2 - A systematic review and meta-analysis
AU - Rehatta, Nancy Margarita
AU - Jaya, Merlin Guntur
AU - Putri, Corinne Prawira
AU - Nugraha, Ricardo Adrian
AU - Putra, Dana Hendrawan
AU - Kamal, Imran Harsam
AU - Kloping, Nabila Ananda
AU - Adityawardhana, Taufan
AU - Jona-Tan, Michael
AU - Kloping, Yudhistira Pradnyan
N1 - Publisher Copyright:
© 2020, The Indonesian Foundation of Critical Care Medicine. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Objective: To evaluate the accuracy of ultraso-nography to assess the increase of intracranial pressure by assessing optic nerve sheath diameter (ONSD) and transcranial Doppler (TCD), consisting of the black box (BB) model, arterial diastolic flow velocity (FVd), critical closing pressure (CrCp), and pulsatility index (PI) as parameters, in adult traumatic brain injury (TBI) patients. Methods: A systematic search through the elec-tronic databases including Medline through PubMed and Embase for studies evaluating the use of optic nerve and TCD USG to evaluate increased intracranial pressure (ICP) compared with the invasive method. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the risk of bias. Results: Ten studies consisting of 727 patients were included in this study. The overall pooled sensitivity and specificity for the prediction of elevated ICP by measuring ONSD were 94% (95% CI: 89%-97%) and 88% (95% CI: 81%-. 95%), respectively. Positive and negative likeli-hood ratios were 12.7 (95% CI: 6.6-25.3; Cochran Q-statistic =14.6; p=0.04) and 0.06 (95% CI: 0.03-0.10; Cochran Q-statistic =14.1; p=0.05), respectively. All I2 values were >0.50. The area under the receiver operating charac-teristic (ROC) curve was 0.92 (95% CI: 0.81-0.98) as shown in the summary ROC (sROC) plot. A meta-analysis could not be performed for the TCD subgroup due to several incomplete sensitivity and specificity data and differences in the evaluated parameters. Four studies evaluated the role of TCD with mixed results. In one study, averaging the parameters of TCD dis-played favorable results. Conclusion: ONSD can be used as a parameter to evaluate the increase of ICP in TBI patients. BB model, FVd, and CrCp are potential prom-ising parameters of TCD ultrasonography for noninvasive ICP estimation as opposed to PI. However, more studies with complete accuracy results are required in the future.
AB - Objective: To evaluate the accuracy of ultraso-nography to assess the increase of intracranial pressure by assessing optic nerve sheath diameter (ONSD) and transcranial Doppler (TCD), consisting of the black box (BB) model, arterial diastolic flow velocity (FVd), critical closing pressure (CrCp), and pulsatility index (PI) as parameters, in adult traumatic brain injury (TBI) patients. Methods: A systematic search through the elec-tronic databases including Medline through PubMed and Embase for studies evaluating the use of optic nerve and TCD USG to evaluate increased intracranial pressure (ICP) compared with the invasive method. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the risk of bias. Results: Ten studies consisting of 727 patients were included in this study. The overall pooled sensitivity and specificity for the prediction of elevated ICP by measuring ONSD were 94% (95% CI: 89%-97%) and 88% (95% CI: 81%-. 95%), respectively. Positive and negative likeli-hood ratios were 12.7 (95% CI: 6.6-25.3; Cochran Q-statistic =14.6; p=0.04) and 0.06 (95% CI: 0.03-0.10; Cochran Q-statistic =14.1; p=0.05), respectively. All I2 values were >0.50. The area under the receiver operating charac-teristic (ROC) curve was 0.92 (95% CI: 0.81-0.98) as shown in the summary ROC (sROC) plot. A meta-analysis could not be performed for the TCD subgroup due to several incomplete sensitivity and specificity data and differences in the evaluated parameters. Four studies evaluated the role of TCD with mixed results. In one study, averaging the parameters of TCD dis-played favorable results. Conclusion: ONSD can be used as a parameter to evaluate the increase of ICP in TBI patients. BB model, FVd, and CrCp are potential prom-ising parameters of TCD ultrasonography for noninvasive ICP estimation as opposed to PI. However, more studies with complete accuracy results are required in the future.
UR - http://www.scopus.com/inward/record.url?scp=85100524685&partnerID=8YFLogxK
M3 - Review article
AN - SCOPUS:85100524685
SN - 1410-7767
VL - 23
SP - 298
EP - 309
JO - Critical Care and Shock
JF - Critical Care and Shock
IS - 6
ER -