The diagnostic and prognostic value of the optic nerve sheath diameter on CT for diagnosis spontaneous subarachnoid hemorrhage

• Published in: The American journal of emergency medicine 2017-10, Vol.35 (10), p.1408-1413
• Main Authors: Yesilaras, Murat, Kilic, Turgay Yilmaz, Yesilaras, Suveyda, Atilla, Ozge Duman, Öncel, Dilek, Çamlar, Mahmut
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysms; Case-Control Studies; Computed tomography; Correlation coefficient; Correlation coefficients; Diagnosis; Emergency; Emergency department; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Female; Gender; Headache; Headaches; Hemorrhage; Humans; Male; Measurement techniques; Medical diagnosis; Medical prognosis; Middle Aged; Mortality; Optic nerve; Optic Nerve - diagnostic imaging; Optic nerve sheath diameter; Pathology; Patients; Predictive Value of Tests; Prognosis; Reproducibility of Results; ROC Curve; Spontaneous subarachnoid hemorrhage; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - diagnosis; Tomography, X-Ray Computed; Ultrasonic imaging; Young Adult
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2017.04.022

Abstract Introduction The aim of this study was to investigate the relationship between the optic nerve sheath diameter (ONSD) measured on non-contrast head computed tomography (CT) and the diagnosis and prognosis of spontaneous subarachnoid hemorrhage (SAH) on emergency department (ED) patients. Method We used a matched control group of patients with the same age and gender who were diagnosed in the ED with spontaneous SAH and who admitted to the ED with headache. Four emergency medicine attending physicians made the ONSD measurements. For measurements, the 3-mm posterior location where the optic nerve enters the eyeball was used. Results This study was done with 61 spontaneous SAHs with an equal number of control patients. The median ONSD for control and spontaneous SAH groups was 5.76 [interquartile range (IQR): 0.96] mm and 6.72 (IQR: 1.42) mm, respectively (p < 0.001). The area under the receiver operating characteristic curve was determined as 0.791 (confidence interval 95% 0.710–0.872). At an ONSD threshold value of 6.1 mm, the sensitivity and specificity of SAH was 72%. There was no significant relationship between ONSD and in-hospital mortality in spontaneous SAH patients (p > 0.05). The intra-class correlation coefficients for inter and intra-rater reliability were 0.84 and 0.95, respectively. Conclusion In patients with spontaneous SAH, the ONSD measured in the orbital sections of a head CT is strongly correlated with a SAH diagnosis. Assessment of ONSD in head CTs taken with spontaneous SAH suspicion may contribute to the diagnoses of spontaneous SAH.