The American journal of emergency medicine · 2026
The test characteristics of ONSD and ODE tests in predicting the prognosis of patients with traumatic brain injury.
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Sahin Ahmet, Akilli Nazire Belgin, Koylu Ramazan
Аннотация
OBJECTIVE: This study aimed to compare the diagnostic and prognostic performance of optic nerve sheath diameter (ONSD) and optic disc elevation (ODE) in patients presenting to the emergency department with isolated head trauma.
MATERIALS AND METHODS: Patients over 18 years of age who presented to the emergency department with a history of isolated head trauma were included. Exclusion criteria were age under 18 years, lack of informed consent, the presence of an orbital hematoma or laceration large enough to interfere with ultrasonographic evaluation, maxillofacial trauma involving orbital injury, optic neuritis, periorbital masses, and pregnancy. Demographic characteristics, vital signs, physical examination findings, and Glasgow Coma Scale (GCS) scores were recorded. ONSD and ODE measurements were obtained. Discharge status, need for surgical intervention, and in-hospital mortality were documented. The predictive abilities of ONSD and ODE for pathological CT findings, surgical intervention, and mortality were compared.
RESULTS: A total of 257 patients were included. Left-sided ODE was associated with a 4.2-fold increase in in-hospital mortality. For predicting the need for surgical intervention, the areas under the curve (AUCs) for right ONSD, right ODE, left ONSD, and left ODE were 0.80 (95% CI: 0.75-0.85), 0.87 (95% CI: 0.82-0.91), 0.80 (95% CI: 0.75-0.85), and 0.86 (95% CI: 0.81-0.90), respectively (p < 0.05). For predicting abnormal CT findings, the AUCs for right ONSD, right ODE, left ONSD, and left ODE were 0.85 (95% CI: 0.80-0.89), 0.87 (95% CI: 0.82-0.90), 0.85 (95% CI: 0.80-0.89), and 0.87 (95% CI: 0.82-0.90), respectively (p > 0.05).
CONCLUSION: ODE appears to be a more robust predictor of mortality and the need for surgical intervention compared with ONSD. Both ONSD and ODE demonstrate similar test performance in identifying abnormal CT findings.
MATERIALS AND METHODS: Patients over 18 years of age who presented to the emergency department with a history of isolated head trauma were included. Exclusion criteria were age under 18 years, lack of informed consent, the presence of an orbital hematoma or laceration large enough to interfere with ultrasonographic evaluation, maxillofacial trauma involving orbital injury, optic neuritis, periorbital masses, and pregnancy. Demographic characteristics, vital signs, physical examination findings, and Glasgow Coma Scale (GCS) scores were recorded. ONSD and ODE measurements were obtained. Discharge status, need for surgical intervention, and in-hospital mortality were documented. The predictive abilities of ONSD and ODE for pathological CT findings, surgical intervention, and mortality were compared.
RESULTS: A total of 257 patients were included. Left-sided ODE was associated with a 4.2-fold increase in in-hospital mortality. For predicting the need for surgical intervention, the areas under the curve (AUCs) for right ONSD, right ODE, left ONSD, and left ODE were 0.80 (95% CI: 0.75-0.85), 0.87 (95% CI: 0.82-0.91), 0.80 (95% CI: 0.75-0.85), and 0.86 (95% CI: 0.81-0.90), respectively (p < 0.05). For predicting abnormal CT findings, the AUCs for right ONSD, right ODE, left ONSD, and left ODE were 0.85 (95% CI: 0.80-0.89), 0.87 (95% CI: 0.82-0.90), 0.85 (95% CI: 0.80-0.89), and 0.87 (95% CI: 0.82-0.90), respectively (p > 0.05).
CONCLUSION: ODE appears to be a more robust predictor of mortality and the need for surgical intervention compared with ONSD. Both ONSD and ODE demonstrate similar test performance in identifying abnormal CT findings.