Feasibility of Optic Nerve Sheath Diameter Measured on Initial Brain Computed Tomography as an Early Neurologic Outcome Predictor After Cardiac Arrest
DC Field | Value | Language |
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dc.contributor.author | Kim, Yong Hwan | - |
dc.contributor.author | Lee, Jun Ho | - |
dc.contributor.author | Hong, Chong Kun | - |
dc.contributor.author | Cho, Kwang Won | - |
dc.contributor.author | Yeo, Jung Hoon | - |
dc.contributor.author | Kang, Mun Ju | - |
dc.contributor.author | Kim, Yang Weon | - |
dc.contributor.author | Lee, Kyoung Yul | - |
dc.contributor.author | Kim, Jin Joo | - |
dc.contributor.author | Hwang, Seong Youn | - |
dc.date.available | 2020-02-28T16:42:13Z | - |
dc.date.created | 2020-02-06 | - |
dc.date.issued | 2014-10 | - |
dc.identifier.issn | 1069-6563 | - |
dc.identifier.uri | https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/12261 | - |
dc.description.abstract | ObjectivesFew parameters are available to predict neurologic outcome of post-cardiac arrest patients in the early stage of treatment. Optic nerve sheath diameter (ONSD) has been used to indirectly assess intracranial pressure. This study evaluated whether ONSD, an additional parameter in initial brain computed tomography (CT) scans, can be an early predictor of neurologic outcome in post-cardiac arrest patients. MethodsA total of 112 cardiac arrest patients between November 2012 and October 2013 were identified. Ninety-eight comatose cardiac arrest patients were evaluated with brain CT. Of these patients, after exclusion of patients whose brain CT scans were done too late or with poor baseline neurology (Cerebral Performance Category [CPC] 3), 91 patients were included for this study. The parameters of initial brain CT, i.e., gray matter-to-white matter ratio (GWR) and ONSD, were measured after clinical care as part of a retrospective reanalysis of images. ONSD on brain CT was bilaterally measured 3 mm behind the eyeball at fixed window width and level and averaged to yield the mean value. The performance of ONSD to predict poor neurologic outcome (CPC = 3 to 5) was analyzed using multiple logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and cross-tabulations. ResultsTwenty-three patients showed good neurologic outcomes at hospital discharge. Mean (SD) ONSD was 5.6 (0.3) mm in the good outcome group versus 6.3 (0.5) mm in the poor outcome group (p < 0.001). After basic clinical covariates were controlled for, i.e., age, Glasgow Coma Scale (GCS) score (3 vs. 4-15), and time from collapse to return of spontaneous circulation (ROSC), ONSD (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.1 to 3.9) and GWR (OR = 0.6; 95% CI = 0.4 to 0.9) were found to be significant factors for predicting poor neurologic outcome. ROC curve analysis showed that ONSD and GWR had areas under the ROC curve of 0.931 (95% CI = 0.87 to 0.98) and 0.922 (95% CI = 0.86 to 0.97), respectively. Combining the cutoff values of ONSD (6.21 mm, sensitivity = 56%; 95% CI = 43% to 68%) and GWR (1.23, sensitivity = 84%; 95% CI = 73% to 92%) to have 100% specificities, the sensitivity was improved to 92% (95% CI = 84% to 98%). Intrarater and interrater intraclass correlation coefficients between the investigators measuring ONSD were 0.888 and 0.833, respectively. ConclusionsOptic nerve sheath diameter on initial brain CT correlated closely with the neurologic outcome of hypoxic ischemic encephalopathy and had good reliability. Additional prospective work may be justified evaluating the standardization and diagnostic performance in real time use as a predictive tool for neurologic outcome following cardiac arrest. Resumen ObjetivosSe dispone de escasos parametros para predecir el resultado neurologico de los pacientes tras una parada cardiaca en la primera etapa del tratamiento. El diametro de la vaina del nervio optico (DVNO) se ha utilizado para evaluar indirectamente la presion intracraneal. Este estudio evaluo si el DVNO, un parametro adicional en las imagenes de la tomografia computarizada (TC) craneal inicial, puede ser predictivo del resultado neurologico en los pacientes tras una parada cardiaca. MetodologiaSe identificaron 112 pacientes con parada cardiaca entre noviembre de 2012 y octubre de 2013. Se evaluaron 98 pacientes en coma por parada cardiaca con TC craneal. De estos pacientes, se incluyeron 91 para este estudio tras la exclusion de los pacientes cuya TC craneal fue realizada demasiado tarde o con un rendimiento neurologico basal pobre (categoria de rendimiento cerebral [CPC] 3). Los parametros de la TC craneal inicial, como por ejemplo la relacion entre la materia gris y la materia blanca (RGB) y el DVNO, se midieron tras la atencion clinica como parte de un reanalisis retrospectivo de las imagenes. El DVNO en la TC craneal se midio bilateralmente 3 mm detras del globo ocular con un nivel y ancho de ventana fijado y realizando un promedio para alcanzar el valor medio. Se obtuvieron los datos demograficos y clinicos. El rendimiento del DVNO para predecir el resultado neurologico pobre (CPC 3-5) se analizo mediante un analisis de regresion logistica multiple, analisis de la curva ROC y tablas de contingencia. ResultadosVeintitres pacientes mostraron un buen resultado neurologico al alta hospitalaria. El DVNO fue 5,6 mm (DE +/- 0,3mm) en el grupo con buen resultado vs. 6,3 mm(DE +/- 0,5 mm) en el grupo con pobre resultado (p< 0.001). Tras ajustar por covariables clinicas basicas (por ejemplo, edad, puntuacion de la Escala de Coma de Glasgow [3 vs 4-15] y el tiempo desde la parada hasta la restauracion de la circulacion espontanea, el DVNO (odds ratio [OR] 2,1; IC 95% = 1,1 a 3,9) y la RGB (OR 0,6; IC 95% = 0,4 a 0,9) fueron finalmente factores significativos de un resultado neurologico pobre. El analisis de la curva ROC mostro que el DVNO y la RGB tuvieron un area bajo la curva de 0,931 (IC 95% = 0,87 a 0,98) y 0,922 (IC 95% = 0,86 a 0,97), respectivamente. La combinacion de los puntos de corte de DVNO (6,21mm, sensibilidad 56%; IC 95% = 43% a 68%) y la RGB (1,23, sensibilidad 84%; IC 95% = 73% a 92%) fijados para tener especificidades de un 100%, hicieron mejorar la sensibilidad a un 92% (IC 95% = 84% a 98%). El coeficiente de correlacion intraclase inter e intraobservador entre los investigadores con la medicion del DVNO fue de 0,888 y 0,833, respectivamente. ConclusionesEl DVNO se correlaciono estrechamente con el resultado neurologico de la encefalopatia isquemica hipoxemica y tuvo una buena fiabilidad. Por lo tanto, un trabajo prospectivo adicional puede estar justificado para evaluar la estandarizacion y el rendimiento diagnostico en el uso a tiempo real como una herramienta predictiva para el resultado neurologico tras una parada cardiaca. | - |
dc.language | 영어 | - |
dc.language.iso | en | - |
dc.publisher | WILEY-BLACKWELL | - |
dc.relation.isPartOf | ACADEMIC EMERGENCY MEDICINE | - |
dc.subject | RAISED INTRACRANIAL-PRESSURE | - |
dc.subject | CEREBRAL-BLOOD-FLOW | - |
dc.subject | THERAPEUTIC HYPOTHERMIA | - |
dc.subject | COMATOSE SURVIVORS | - |
dc.subject | CARDIOPULMONARY-RESUSCITATION | - |
dc.subject | NORMATIVE MEASUREMENTS | - |
dc.subject | WHITE-MATTER | - |
dc.subject | CT | - |
dc.subject | INJURY | - |
dc.subject | ULTRASONOGRAPHY | - |
dc.title | Feasibility of Optic Nerve Sheath Diameter Measured on Initial Brain Computed Tomography as an Early Neurologic Outcome Predictor After Cardiac Arrest | - |
dc.type | Article | - |
dc.type.rims | ART | - |
dc.description.journalClass | 1 | - |
dc.identifier.wosid | 000343822800007 | - |
dc.identifier.doi | 10.1111/acem.12477 | - |
dc.identifier.bibliographicCitation | ACADEMIC EMERGENCY MEDICINE, v.21, no.10, pp.1121 - 1128 | - |
dc.identifier.scopusid | 2-s2.0-84908121599 | - |
dc.citation.endPage | 1128 | - |
dc.citation.startPage | 1121 | - |
dc.citation.title | ACADEMIC EMERGENCY MEDICINE | - |
dc.citation.volume | 21 | - |
dc.citation.number | 10 | - |
dc.contributor.affiliatedAuthor | Kim, Jin Joo | - |
dc.type.docType | Article | - |
dc.subject.keywordPlus | RAISED INTRACRANIAL-PRESSURE | - |
dc.subject.keywordPlus | CEREBRAL-BLOOD-FLOW | - |
dc.subject.keywordPlus | THERAPEUTIC HYPOTHERMIA | - |
dc.subject.keywordPlus | COMATOSE SURVIVORS | - |
dc.subject.keywordPlus | CARDIOPULMONARY-RESUSCITATION | - |
dc.subject.keywordPlus | NORMATIVE MEASUREMENTS | - |
dc.subject.keywordPlus | WHITE-MATTER | - |
dc.subject.keywordPlus | CT | - |
dc.subject.keywordPlus | INJURY | - |
dc.subject.keywordPlus | ULTRASONOGRAPHY | - |
dc.relation.journalResearchArea | Emergency Medicine | - |
dc.relation.journalWebOfScienceCategory | Emergency Medicine | - |
dc.description.journalRegisteredClass | scie | - |
dc.description.journalRegisteredClass | scopus | - |
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