응급실에 내원한 두부외상환자의 2차 평가로써 초음파를 이용한 시각신경집 지름 측정은 유용한가?

• Published in: Daehan oe'sang haghoeji Vol. 26; no. 3; pp. 104 - 110
• Main Authors: 이동욱, Dong Wook Lee, 이정원, Jung Won Lee, 박세훈, Sae Hoon Park, 박일성, Ihl Sung Park, 이현정, Hyun Jung Lee, 유병대, Byeong Dae Yoo, 문형준, Hyung Jun Moon
• Format: Journal Article
• Language: Korean
• Published: 대한외상학회 30.09.2013
• Subjects: Head injuries; Intracranial pressure; Optic nerve; Ultrasonography; Head injuries; Optic nerve; Intracranial pressure; Ultrasonography
• ISSN: 1738-8767; 2799-4317; 2287-1683

Purpose: Bedside ultrasonography is available in most emergency departments, and detecting the intracranial pressure is elevated is critical. Our objective is to evaluate the availability of bedside optic nerve ultrasound (ONUS) as a secondary survey for patients with head injuries in the emergency department (ED). Methods: From September, 2012, to March, 2013, we performed a prospective study of patients presenting to the ED after an accident. Patients with head injuries but without obvious ocular trauma or ocular disease were included. The ONUS was performed using a 3 to 12 MHz linear probe on closed eyelids after a primary survey. We analyzed the correlation between the brain computed tomography (CT) findings that suggested elevated intracranial pressure (ICP) and the Optic nerve sheath diameter (ONSD) measured by using ONUS. Results: A total of 81 patients were enrolled. Forty-seven had CT results consistent with elevated ICP, and their mean ONSD was 5.98±0.59 mm; the mean ONSD of patients who showed no signs of elevated ICP on CT was 4.63±0.21 mm. The sensitivity and the specificity for the ONSD, compared with elevated ICP, were 98.87% and 100%, respectively, when the cut-off value was set to 4.96 mm. The area under curve (AUC) was 0.997 in the receiver operating characteristic curve (ROC curve). Conclusion: An evaluation using ONUS is a simple noninvasive procedure and is a potentially useful tool as a secondary survey to identify an elevated ICP.