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J Korean Soc Emerg Med > Volume 28(3); 2017 > Article
Journal of The Korean Society of Emergency Medicine 2017;28(3): 231-239.
외상성 뇌출혈 환자에서 수술 적응증 예측인자로서 초음파를 이용한 양안 시신경초 직경 차이의 유용성
박찬중, 선경훈, 조수형, 김성중
조선대학교 의과대학 응급의학교실
The Utility of Measuring the Difference between the Two Optic Nerve Sheath Diameters Using Ultrasonography in Predicting Operation Indication in Patients with Traumatic Brain Hemorrhage
Chan Jung Park, Kyung Hoon Sun, Soo Hyung Cho, Seong Jung Kim
Department of Emergency Medicine, Chosun University School of Medicine, Gwangju, Korea
Correspondence  Kyung Hoon Sun ,Tel: 062-220-3285, Fax: 062-224-3501, Email: skhkorea@hanmail.net,
Received: December 28, 2016; Revised: December 28, 2016   Accepted: April 17, 2017.  Published online: June 30, 2017.
ABSTRACT
Purpose:
An increase in optic nerve sheath diameter (ONSD) has been associated with elevated intracranial pressure due to brain lesions, such as hemorrhage, infarction, and tumor. The aim of this study was to evaluate whether the difference of both ONSDs can predict surgical treatment in patients with traumatic brain hemorrhage.
Method:
A prospective analysis of the data acquired between September 2016 and November 2016 was performed. We included 155 patients with traumatic brain hemorrhage undergoing computed tomography in the emergency room. We performed an ultrasonography to measure ONSDs for all included patients. The primary outcome of this study was operation indication in patients with traumatic brain hemorrhage.
Results:
The average age was 63.4±17.0 years (male 60.3±17.3, female 69.8±14.4). There were 61 (39.35%) patients with an indication for operation and 94 (60.65%) patients with an indication for no operation. Indications for operation showed a strong association with the difference of both ONSDs in patients with subdural hemorrhage (p<0.001), no association between them in patients with epidural and intracerebral hemorrhage. In patients with subdural hemorrhage, the area under the curve was 0.988 (0.653-0.998), and the cut-off value for the difference of ONSDs with respect to determining the indications for operation was 0.295 mm f maximizing the sum of the sensitivity (96.9%) and specificity (90.7%) using the receiver operating curve.
Conclusion:
A difference of both ONSDs above 0.295 mm was useful in predicting the indications for operation in patients with traumatic subdural hemorrhage, but not in patients with epidural and intracerebral hemorrhage.
Key words: Optic nerve, Ultrasonography, Hematoma; subdural, Hematoma; epidural; cranial, Cerebral hemorrhage
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