Inter‐rater Reliability of Sonographic Optic Nerve Sheath Diameter Measurements by Emergency Medicine Physicians

Oberfoell, Stephanie; Murphy, David L.; French, Arthur B.; Trent, Stacy A.; Richards, David B.

doi:10.7863/ultra.16.05055

Cited by 35 publications

(31 citation statements)

References 10 publications

(20 reference statements)

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“…The degree of agreement for post hoc measurements of the ONSD was slightly lower, but still clinically acceptable, with an intrareader correlation coefficient at the lower end of the "optimal" range, and an interreader coefficient at the upper end of the "strong" range. This is not unexpected, given the technical challenges associated with this assessment, and is in keeping with the findings of earlier studies …”

Section: Discussionsupporting

confidence: 87%

Optic nerve sonography and ophthalmic artery Doppler velocimetry in healthy pregnant women: an Australian cohort study

Kane

Dennis

Costa

et al. 2019

J of Clinical Ultrasound

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Purpose Maternal ocular sonography offers a window into cerebrovascular and intracranial pressure changes in pregnancy. This study aimed to determine the Doppler velocimetric variables of the ophthalmic artery, and the mean diameter of the optic nerve sheath (ONSD), in an Australian cohort of healthy pregnant women. Methods A prospective observational cohort study of healthy women with uncomplicated singleton pregnancies in the third trimester was undertaken in a tertiary maternity service. A single prenatal ultrasonographic examination was performed on all participants, with a postnatal examination performed on a subgroup with uncomplicated deliveries. Results Fifty women were examined at a mean gestation of 35 weeks. The mean ± SD Doppler variables in the ophthalmic artery were peak systolic velocity (PSV) 41.89 ± 13.13 cm/s, second peak velocity 20.63 ± 8.97 cm/s, end diastolic velocity 9.29 ± 5.13 cm/s, pulsatility index 1.97 ± 0.53, resistive index 0.78 ± 0.07, peak ratio (second peak velocity/PSV) 0.49 ± 0.12, while the mean ONSD was 4.34 ± 0.4 mm. None of these variables had a demonstrable relationship with gestation or mean arterial pressure (MAP), nor did the sheath diameter have a relationship with any of the Doppler variables. Conclusions The ocular sonographic variables observed in this population are similar to those reported in other cohorts. No clear relationship could be identified in this cohort between ophthalmic artery Doppler variables and the ONSD, and between each of these variables and gestation or MAP.

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Section: Discussionsupporting

confidence: 87%

Optic nerve sonography and ophthalmic artery Doppler velocimetry in healthy pregnant women: an Australian cohort study

Kane

Dennis

Costa

et al. 2019

J of Clinical Ultrasound

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“…In the present study, although we didn't evaluate the ICC of emergency medicine residents, the ICC of ONST on facial CT was found to be over 0.9, which is remarkably high. 19 Additionally, we previously demonstrated that the ONSD on facial CT had a feasible predictive performance in identifying TBI. 15 Here, we found no difference between ONSD and ONST on facial CT.…”

Section: Discussionmentioning

confidence: 98%

Comparative and retrospective evaluation of the predictive performance of optic nerve sheath thickness and optic nerve sheath diameter for traumatic brain injury using facial computed tomography

Sim

Lee

Yun³

et al. 2020

Clin Exp Emerg Med

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Objective To evaluate the predictive performance of optic nerve sheath thickness (ONST) on the outcomes of traumatic brain injury (TBI) and to compare the inter-observer agreement To evaluate the predictive performance of optic nerve sheath thickness (ONST) for traumatic brain injury (TBI) and to compare the predictive performance and inter-observer agreement between ONST and optic nerve sheath diameter (ONSD) on facial computed tomography (CT). Methods We retrospectively enrolled patients with a history of facial trauma and who underwent both facial CT and brain CT. Two reviewers independently measured ONST and ONSD of each patient using facial CT images. Final brain CT with clinical outcome was used as the reference standard for TBI. Multivariate logistic regression analyses, receiver operating characteristic (ROC) curves, and intraclass correlation coefficients were used for statistical analyses. Results Both ONST (P = 0.002) and ONSD (P = 0.001) on facial CT were significantly independent factors to distinguish between TBI and healthy brains; an increase in ONST and ONSD values corresponded with an increase in the risk of TBI by 8.9-and 7.6-fold, respectively. The predictive performances of the ONST (sensitivity, 96.2%; specificity, 94.3%; area under the ROC curve, 0.968) and ONSD (sensitivity, 92.6%; specificity, 90.2%; area under the ROC curve, 0.955) were excellent and exhibited similar sensitivity, specificity, and area under the curve (P = 0.18-0.99). Interobserver and intraobserver intraclass correlation coefficients for ONST were significantly higher than those for ONSD (all P < 0.001). Conclusion ONST on facial CT is a feasible predictor of TBI and demonstrates similar performance and superior observer agreement than ONSD. We recommend using ONST measurements to assess the need for additional brain CT scans in TBI-suspected cases.

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“…Although standard portable ultrasound units have been extensively tested and have been determined to be reasonably accurate for measurement of ONSD and determination of ICP, [11][12][13]15,16 newer handheld units are continuously being added to the market. New pocket ultrasound devices are not identical to previously validated portable ultrasound, nor are they identical to the pocket Vscan unit that we have previously found to be accurate.…”

Section: Discussionmentioning

confidence: 99%

“…As with any ultrasound measurement, ONSD sonography has been shown to be operator dependent with small to moderate inter-observer and intra-observer variation reported in the literature. [11][12][13][14][15][16] It has been previously shown that this variance can be improved with practice. 15,17 There is growing evidence that simulation is effective for developing and assessing both technical and non-technical skills.…”

Section: Introductionmentioning

confidence: 99%

A New Inexpensive Simulation Model for Ultrasound Assessment of Optic Nerve Sheath Diameter

Jelic

Derksen

Unger

et al. 2020

Can. J. Neurol. Sci.

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ABSTRACT:Background:Sonographic measurement of optic nerve sheath diameter (ONSD) is becoming increasingly accepted as a diagnostic modality to detect elevations in intracranial pressure. As this technique becomes more widespread, methods to address the inherent operator-dependent nature of this modality will need to be developed. We propose a novel low-cost model to accurately simulate sonographic ONSD measurement for purposes of training and assessment.Methods:We designed models composed of medical tubing of various diameters readily available from typical hospital supplies and suspended them in gelatin. The models were evaluated by ultrasound by three expert point-of-care sonographers using a standard linear array probe and technique proposed in the literature.Results:This model generates faithful simulation of the ONS that closely approximates in vivo images and can be used to produce accurate, reproducible measurements. Materials are low cost and easy to acquire and assemble.Conclusions:Our model provides realistic simulated images of the ONS. Through comparison of sonographic measurements to the known tube diameters, this model serves as a promising inexpensive tool to teach the method of ultrasound assessment of ONSD or as a way to determine accuracy of this novel ultrasound technology.

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Inter‐rater Reliability of Sonographic Optic Nerve Sheath Diameter Measurements by Emergency Medicine Physicians

Cited by 35 publications

References 10 publications

Optic nerve sonography and ophthalmic artery Doppler velocimetry in healthy pregnant women: an Australian cohort study

Optic nerve sonography and ophthalmic artery Doppler velocimetry in healthy pregnant women: an Australian cohort study

Comparative and retrospective evaluation of the predictive performance of optic nerve sheath thickness and optic nerve sheath diameter for traumatic brain injury using facial computed tomography

A New Inexpensive Simulation Model for Ultrasound Assessment of Optic Nerve Sheath Diameter

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