Diagnostic Accuracy of Optic Nerve Ultrasonography and Ophthalmoscopy in Prediction of Elevated Intracranial Pressure

Introduction: elevated intracranial pressure (icp) is a major and potentially lethal disorder in patients admitted to the emergency department (ed). several methods are being used to investigate for elevated icp. here we as-sessed and compared the diagnostic accuracy of two existing tools of ophthalmoscopy and optic nerve ultrasonog-raphy in detection of elevated icp. methods: 131 participants with probable elevation of icp referred to the emer-gency department of al-zahra hospital, isfahan, iran, from 2012 to 2014, were enrolled. brain computed tomogra-phy (ct) scan, ultrasonography of optic nerve sheath, and ophthalmoscopy were performed for them. the optic nerves sheath with diameter more than 5 millimeters was considered as elevated icp. widening of optic nerve, ocular venous engorgement, blurring, hemorrhage over optic disk, elevation of optic disk, and retinal venous tor-tuosity were recorded as evidences of icp rising in ophthalmoscopy. diagnostic accuracy of the two tools in predic-tion of icp rising were compared with the results of brain ct scan as a gold standard. results: the mean age of participants was 46.29 ± 10 years (77% male). the number of diagnosed elevated icps with ophthalmoscopy and ultrasound were 98 (74.8%) and 102 (77.9%) cases, respectively. the calculated sensitivity and specificity of oph-thalmoscopy and ultrasonography in detection of icp rising were 100.0% (95% ci: 88.6-100.0) and 35.4% (95% ci: 26.0-46.2), 100.0% (95% ci: 84.0-100.0) and 31.9% (95% ci: 23.0-41.7), respectively. conclusion: the present study revealed that bedside ultrasonography of optic nerve sheath and ophthalmoscopy have enough accuracy for the screening of patients with probable elevation of icp. of course, it should be considered that despite the high sensitivity of both tools, their specificity is low.