Noninvasive Methods for Measurement of Intracranial Pressure in Patients with Acute Neurotrauma: A Systematic Review and Meta-Analysis.
Allice Nyborg Rosenkrans Lind, Maria Hjort Kristensen, Victor Hvingelby et al.
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In 30 seconds
This systematic review and meta-analysis of diagnostic test accuracy assessed minimally invasive, transportable methods for detecting elevated intracranial pressure (ICP), with a focus on potential prehospital use in acute neurotrauma. Fifty-five articles were included. Ultrasound measurement of optic nerve sheath diameter (ONSD) had the greatest prehospital potential; its summarized sensitivity was 92.6% (95% confidence interval [CI]: 87.0; 95.9%) and specificity was 85.1% (95% CI: 74.1; 92.0%) for detecting increased ICP. Other methods generally had poor diagnostic accuracy or limited prehospital potential.
Key findings
- Across studies, ONSD ultrasound had summarized sensitivity of 92.6% (95% CI: 87.0; 95.9%) for detecting increased ICP.
- ONSD ultrasound had summarized specificity of 85.1% (95% CI: 74.1; 92.0%) for detecting increased ICP.
- Other assessed methods showed poor diagnostic accuracy or low potential for prehospital use.
Why it matters
Invasive ICP monitoring is not compatible with prehospital use, creating a need for transportable screening approaches. The review identifies ONSD ultrasound as the strongest candidate among the methods assessed, while its pooled diagnostic performance provides a basis for further evaluation. Reliable prehospital screening could help identify patients with elevated ICP, but the evidence does not yet establish performance in that setting.
What to keep in mind
The authors state that prospective studies are needed to verify diagnostic capability in the prehospital setting; the reported accuracy therefore does not establish real-world prehospital performance.