目的:在儿科患者早期检测颅内压升高是至关重要的,因为早期开始治疗可以预防发病率和死亡率。这项研究的目的是确定通过超声测量的ONSD的诊断准确性,以预测颅内压升高。
方法:四个数据库,即,PubMed,EMBASE,Scopus&CINAHL,进行了系统评价和荟萃分析。研究预定义的纳入标准考虑了诊断准确性,横截面,前瞻性观测,和回顾性研究,重点是儿童颅内压升高的原因,如创伤性脑损伤和脑水肿,评估了使用超声测量的视神经鞘直径的诊断准确性.主要结果指标包括敏感性,特异性。该研究包括侵入性监测(EVD)和非侵入性措施作为颅内压升高的金标准。两位作者提取并回顾了数据。基线数据,结果衡量标准,并提取诊断准确性数据。
结果:分析了25项研究,包括1,591例患者和3,143例通过超声进行的ONSD测量。通过超声测量的ONSD预测颅内压升高的合并敏感性和特异性分别为92%(86-96%)和89%(77-96%),分别。合并的阳性和阴性似然比分别为8.6和0.08。
结论:视神经超声检查作为一种精确和有价值的诊断工具,适用于不同的患者人群和临床情况。我们建议在儿科患者中进行常规眼部超声检查以测量视神经鞘直径,以提高诊断颅内压升高的准确性。
OBJECTIVE: Detecting increased intracranial pressure early in pediatric patients is essential, as early initiation of therapy prevents morbidity and mortality. The objective of this study was to determine the diagnostic accuracy of the ONSD measured via ultrasound for the prediction of increased intracranial pressure.
METHODS: Four databases, namely, PubMed, EMBASE, Scopus & CINAHL, were searched for this systematic review and meta-analysis. The study\'s predefined inclusion criteria considered diagnostic accuracy, cross-sectional, prospective observational, and retrospective studies with a focus on children with elevated intracranial pressure from causes such as traumatic brain injury and cerebral edema, the diagnostic accuracy of the optic nerve sheath diameter measured using ultrasound was assessed. The primary outcome measures included sensitivity, specificity. The study included invasive monitoring (EVD) and noninvasive measures as the gold standards for increased intracranial pressure. Two authors extracted and reviewed the data. Baseline data, outcome measures, and diagnostic accuracy data were extracted.
RESULTS: Twenty-five studies with 1,591 patients and 3,143 ONSD measurements via ultrasound were analyzed. The pooled sensitivity and specificity of the ONSD measured via ultrasound for the prediction of increased intracranial pressure were 92% (86-96%) and 89% (77-96%), respectively. The pooled positive and negative likelihood ratios were 8.6 and 0.08, respectively.
CONCLUSIONS: Optic nerve ultrasonography stands out as a precise and valuable diagnostic tool applicable across diverse patient populations and clinical scenarios. We recommend routine ocular ultrasound for optic nerve sheath diameter measurement in pediatric patients to increase the accuracy of diagnosing increased intracranial pressure.