Diagnostic accuracy of ultrasonographic optic nerve sheath diameter for detecting increased intracranial pressure in traumatic brain injury: An umbrella review on previous systematic reviews

Abstract

Traumatic brain injury (TBI) frequently results in increased intracranial pressure (ICP), which may cause irreversible damage or fatality if not addressed. Prompt and precise detection of ICP is essential, particularly in emergency situations. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) has been suggested as a noninvasive technique for identifying ICP. This study seeks to evaluate the diagnostic accuracy of ONSD through ultrasonography in TBI patients. An umbrella review was performed in accordance with preferred reporting items for systematic reviews and meta‐analyses guidelines, concentrating on systematic reviews and meta‐analyses that detail diagnostic accuracy metrics for ONSD in TBI patients. Studies were incorporated if they provided data on sensitivity, specificity, or area under the curve (AUC) for ONSD in the detection of ICP. The AMSTAR 2 tool was used to figure out the risk of bias, and random‐effects models were used to put the results together. The combined analysis of 41 incorporated studies, showed that the test was very accurate: it had a sensitivity of 0.89 (95% CI: 0.85–0.92), a specificity of 0.84 (95% CI: 0.80–0.89), and an AUC of 0.94 (95% CI: 0.91–0.95). The diagnostic odds ratio was 46 (95% CI: 26–81). Subgroup analyses demonstrated consistency among ONSD cut‐off values and ICP thresholds, notwithstanding significant heterogeneity. Ultrasonography measurement of ONSD shows that it is very accurate for finding high ICP in TBI patients. It offers a dependable, noninvasive screening instrument, especially in emergency contexts. Nevertheless, standardized measurement protocols and additional research are essential to enhance diagnostic thresholds.