Diagnostics and prediction of intracranial hypertension on primary computed tomography in patients with severe traumatic brain injury

Abstract

 The objective was to compare the optic nerve sheath diameter measured by CT (ODSN-CT) with the level of compression of the mesencephalic  cisterns and the midline shift in the diagnosis and prediction of intracranial hypertension (ICH) during the first 3 days after brain injury. Materials and methods. We examined 90 patients with TBI, the average age was 34.2 ± 13 years, GCS < 9. All patients had invasive ICP monitoring.  At the time of implantation of the ICP sensor, intracranial hypertension (ICH) was in 11 (12%) patients; later, during the first 3 days, the development of ICH was in 58 (64%) patients. All patients underwent computed tomography of the head at the time of hospitalization: mesencephalic  cisternae was compressed in 57 (63%) and midline shift was observed in 34 (38%) patients, mean value of ONSD-CT was 7.26 ± 0.9 mm, maximum  value of ONSD-CT was 7.34 ± 0.9. We used correlation analysis, logistic regression and ROC-analysis.Results. The level of mesencephalic cisternae compression, mean and maximum value of ONSD-CT correlated with the ICP value measured at the  time of ICP sensor implantation and during the first 72 hours after brain injury (p < 0.05). Midline shift did not correlate with ICP value measured  at the time of sensor implantation and during the first 72 hours after brain injury (p > 0.05). In the diagnosis of ICP > 20 mm Hg at the time of  implantation of the sensor – the average ONSD-CT, AUC 0.902 ± 0.046 (0.812; 0.991), cut-off 7.8 mm with sensitivity and specificity of 82 and  80%, respectively. When predicting ICP > 20 mm Hg in the first 72 hours - the maximum ONSD-CT, AUC 0.815 ± 0.047 (0.724; 0.907), cut-off  7.1 mm with sensitivity and specificity of 85 and 66%, respectively.Conclusions. The ONSD-CT parameter is an independent diagnostic and prognostic criterion of ICH in the first 3 days in patients with severe  TBI. The mean ONSD-CT can be used to diagnose ICH along with such signs of ICP as level of mesencephalic cisterna compression and midline  shift and to make a decision on invasive ICP monitoring. The maximum value of ONSD-CT can be used to assess the probability of ICH in the  first three days after TBI