Predictive value of ultrasound measurement of optic nerve sheath diameter combined with Pcv-aCO2/Ca-cvO2 to evaluate intracranial hypertension in pre-hospital TBI patients
Objective:To explore the value of ultrasound measurement of optical nerve sheath diameter(ONSD)combined with Pcv-aCO2/Ca-cvO2 to evaluate intracranial hypertension in patients with traumatic brain injury(TBI).Methods:To collect patients with TBI admitted to the First People's Hospital of Changde from Janu-ary 2023 to December 2023.A total of 54 TBI patients were included in this study,including 24 males and 30 fe-males,with an average age of(57.13±4.02)years.External ventricular drainage was used to monitor invasive intracranial pressure(ICP)in enrolled patients,and ONSD and Pcv-aCO2/Ca-cvO2 were recorded within 3 days af-ter admission to the ward.Compare the levels of ONSD,Pcv-aCO2/Ca-cvO2 and the level of ICP in the same peri-od and analyze the correlation between them.ROC curves were used to determine the optimal critical values for di-agnosing intracranial hypertension(ICP＞20 mmHg,1 mmHg=0.133 kPa)using ONSD,Pcv-aCO2/Ca-cvO2,and evaluate the predictive ability of ONSD,Pcv-aCO2/Ca-cvO2,and ONSD combined with Pcv-aCO2/Ca-cvO2 for intracranial hypertension.Results:The results of linear regression analysis showed a correlation between ONSD(r=0.74,P＜0.01),Pcv-aCO2/Ca-cvO2(r=0.70,P＜0.01)and ICP.Through ROC curve analysis,it was found that ONSD and Pcv-aCO2/Ca-cvO2 had good predictive value for intracranial hypertension in TBI pa-tients.The area under curve(AUC)of the ONSD was 0.861(95％CI:0.727-0.951),while the Pcv-aCO2/Ca-cvO2 AUC was 0.791(95％CI:0.673-0.889).The optimal critical value for diagnosing elevated ICP in ONSD was 5.62 mm,with a sensitivity of 92.8％and a specificity of 80.4％.The optimal critical value for diagnosing elevated ICP with Pcv-aCO2/Ca-cvO2 was 1.98 mmHg/mL,with a sensitivity of 87.3％and a specificity of 77.2％.The combination of ONSD and Pcv-aCO2/Ca-cvO2 could further improve the predictive value of intracra-nial hypertension in TBI patients,with an AUC of 0.952(95％CI:0.869-0.971),sensitivity of 95.1％,and specificity of 93.9％.Conclusion:ONSD and Pcv-aCO2/Ca-cvO2 have a good correlation with intracranial pressure levels in TBI patients,and their combination can serve as a basis for determining whether there is intracranial hy-pertension in pre hospital TBI patients.
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