The value of optic nerve sheath diameter measurement in assessing intracranial pressure using bedside ultrasound in resource limited setting
EANS Academy. Aklilu A. 09/27/19; 276116; EP14005
Abenezer Aklilu
Abenezer Aklilu

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Background: Currently customary practice at Black lion hospital, a biggest tertiary hospital in Ethiopia, when dealing with patients who sustained traumatic brain injury is widely based on clinical judgment. Their neuro status is monitored using only their serial neurologic examination and basic laboratory work-up. It is only when they deteriorate significantly that they are sent to the CT scan. It is often difficult to send ICU patients who are on respirator to the CT scan. Thus, there is often a significant delay to get the CT results which might take days.
Objectives: The purpose of this pilot study was to evaluate ICP in patient with head trauma (severe, moderate or mild) and assess the value of bedside ultrasound in assessing the ICP and the potential effectiveness in decision making process.
Methods All patients that present to the ED or refereed to the Neurosurgery service with presumed ICP as a complication of trauma were included in the study. physicians with basic ocular US training continue their current practice in managing patients who have suspected ICP and add bedside ultrasound evaluation of the ONSD and document whether or not the results of the bedside ultrasound would have changed/altered their management decisions.
Results: A total of 38 ocular ultrasound were performed and only 28 patients had complete information on the optic nerve sheath measurement. Of these 28 patients 26 patients had bilateral ONSD measurements. Ten patients had an ONSD of 6mm and above [(considered pathological reflecting increased intracranial pressure of which 4 patients had severs TBI (GCS< 9).
Conclusions: Bedside ONSD measurement can be a reliable means to follow and augment clinical decision-making process on management of patients with raised ICP following trauma or other causes in a setup where invasive ICP monitoring is non-existing and doing serial CT-scan is not practical.
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