Validity and reliability of pocket-sized ultrasound devices in measurement of optic nerve sheath diameter in ICU patients

Abstract

The measurement of the optic nerve sheath diameter (ONSD) by ultrasonography (USG) is particularly important for intracranial pressure (ICP) monitoring when invasive measurements are not possible or are contraindicated. Standard USG (SUDs) devices can be bulky and may break down the workflow. The validity and reliability of pocket-sized USG devices (PSUDs) compared to SUDs for ONSD measurement has not been investigated, yet. We compared the reliability and validity of PSUDs with SUDs for ONSD measurement. 35 patients were included in the study. ONSD measurements with PSUDs and SUDs were performed by two clinicians as three different measurements in both sagittal and transverse axis of the eye. There was agreement between mean transverse ONSD (mtONSD), mean sagittal ONSD (msONSD), and mean ONSD(mONSD) values measured with each device according to Bland-Altman test (p = 0.166, p = 0.135, p = 0.066, respectively) with no proportional bias (p = 0.544, p = 0.868, p = 0.929, respectively). Intraclass correlation coefficients (ICC) were found to be greater than 0.7 for mtONSD, msONSD, and mONSD values measured by SUD (ICC = 0.790, ICC = 0.817, and ICC = 0.844, respectively). Similarly, for mtONSD, msONSD, and mONSD values measured by PSUD, ICC were found greater than 0.7 (ICC = 0.763, ICC = 0.814, and ICC = 0.843, respectively). There was no statistically significant difference between mtONSD and msONSD (p = 0.441 for SUD and p = 0.893 for PSUD). There was a good correlation between mtONSD and msONSD (r = 0.767 for SUD and r = 0.816 for PSUD). The total variance between three different measurements in the transverse and sagittal axis was ± 0.6 mm. PSUDs can be used with similar validity and reliability as SUDs for ONSD measurement.

Optic nerve sheath diameter measurement by ultrasound: Evaluation of a standardized protocol

“…15 The only previous study using ICC for inter-rater reliability of ONSD ultrasound in intensive care patients reported an ICC of 0.84 (no 95% CI reported). 16 With the excellent intra-and inter-rater results emanating from the current study, we suggest that all ONSD examinations should be standardized and based on the CLOSED protocol. Based on the nonsignificant trend favoring an increased number of measurements, we also suggest that ONSD should be measured at least twice from every angle to improve precision.…”

“…ICC was 0.74 (95% CI; 0.65, 0.81) for inter‐rater reliability 15 . The only previous study using ICC for inter‐rater reliability of ONSD ultrasound in intensive care patients reported an ICC of 0.84 (no 95% CI reported) 16 …”

One-day seminar for residents for implementing abdominal pocket-sized ultrasound

“…Decontamination assessment must never be compromised. Some recent studies have shown that pocket-sized US performed efficiently as a tool for screening a variety of diseases[ 16 , 20 , 29 , 30 , 34 , 41 ]. The pocket-sized US devices were also used successfully by other healthcare providers, such as nurses and physical therapists.…”

Ultrassonografia point of care do nervo óptico na avaliação da hipertensão intracraniana no paciente neurocrítico

“…Ainda, possui a vantagem de fácil aprendizado, não causa complicações e pode ser aplicado à beira leito por médicos emergencistas e intensivistas. Todavia, ainda não existem recomendações específicas sobre o seu uso (PANSELL et al, 2023;ÖZDEMIR et al, 2019).…”