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J Korean Soc Emerg Med > Volume 28(4); 2017 > Article
Journal of The Korean Society of Emergency Medicine 2017;28(4): 334-344.
뇌출혈 환자에서 두부 전산화 단층 촬영을 통해 측정한 시각 신경집 지름 크기의 유용성
유재광1, 김양원1, 강지훈1, 윤유상1,2*
1인제대학교 의과대학 응급의학교실
2인제대학교 인문의학연구소
Availability of the Optic Nerve Sheath Diameter Measured by Using Brain CT in Intracranial Hemorrhage
Jae Kwang Yu1, Yang Weon Kim1, Ji Hun Kang1, Yoo Sang Yoon1,2*
1Department of Emergency Medicine, Inje University College of Medicine, Busan, Korea
2The Institute for Medical Humanities, Inje University, Busan, Korea
Correspondence  Yoo Sang Yoon ,Tel: 051-890-6120, Fax: 051-891-1465, Email: 101mars@hanmail.net,
Received: April 6, 2017; Revised: April 10, 2017   Accepted: June 15, 2017.  Published online: August 31, 2017.
ABSTRACT
Purpose:
This study was designed to evaluate the applicability of optic nerve sheath diameter (ONSD), as measured by a brain CT, in intracranial hemorrhage patients. We assumed that ONSD can be used to make surgical decisions and be considered as a predictive factor for mild intracranial hemorrhage (survival and neurologic outcomes) compared with the Glasgow Coma Scale (GCS) score.
Method:
This retrospective study included 457 patients between January 2016 and September. They were divided into two groups: Those with GCS of between 13 and 15, and those with GCS of below 12. ONSD measurements were taken using a brain computed tomography in the axial view. Using SPSS Statistics ver. 20.0, ONSD was analyzed by a binary logistic regression analysis. Receiver operating characteristics (ROC) curves were used to find the cut-off value that maximized the sum of sensitivity and specificity in both groups to evaluate the feasibility of using ONSD for surgical decision and as a predictive factor (survival and neurologic outcomes).
Results:
The mean ONSD in mild hemorrhage patients was 5.43 mm. The odd ratio in the mild intracranial hemorrhage group for surgical decision was 5.030. The area under the ROC curve of mean ONSD in mild hemorrhage for surgical decision was 0.789. The cut-off value was 5.46 mm; sensitivity was 81.6% and Specificity was 75.0%. Positive and negative predictive values were 80.7% and 76.4%, respectively.
Conclusion:
The mean ONSD, when compared with the GCS score, is a valuable factor for making surgical decisions in cases of mild intracranial hemorrhage.
Key words: Intracranial hemorrhages, Intracranial pressure, Optic nerve, Glasgow Coma Scale
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