2089631 Correlation Of Sonographic Measured Optic Nerve Sheath Diameter and Lumbar Puncture Opening Pressure In Emergency Department Headache Patients

ObjectivesTo identify the best optic nerve sheath diameter (ONSD) cutoff among emergency department patients presenting with nontraumatic headache who require urgent intervention for the treatment of elevated intracranial pressure.MethodsA retrospective chart review was performed on 252 charts going back 2.5 years. Charts were extracted from the Emergency Department ultrasound database specifically searching patients who had ONSD measurements over the 2.5-year study period. Ultimately, 34 patients met criteria for inclusion in the study. Inclusion criteria consisted of patients 18 years of age, presented to the emergency department with headache, no documented recent history of head trauma, ONSD measured, and lateral decubitus lumbar puncture opening pressure recorded for the same visit. The patient records were reviewed for emergency department intervention and operative intervention. Discharge summary and clinic notes were reviewed for final diagnosis and outpatient management. Bilateral sonographic ONSDs were averaged and recorded for comparison to opening pressure and outcome. A receiver operator characteristic (ROC) curve was built to compare ONSD with patients who had elevated ICP requiring immediate intervention.ResultsIn our group of 34 patients, 9 were found to have elevated ICP requiring immediate intervention. 8 patients had idiopathic intracranial hypertension and 1 patient had venous sinus thrombosis. Among the immediate intervention group the average opening pressure was 46 cm H2O with an average ONS diameter of 6.2mm. The 5.0mm ONSD cutoff had a sensitivity of 100% and specificity of 46%. The 5.5mm ONSD cutoff had a sensitivity of 89% and specificity of 85%. The 6.0mm cutoff had a sensitivity of 67% and a specificity of 100%.ConclusionsFor Emergency Department patients presenting with headache a sonographic ONSD greater than 5.5mm is both sensitive and specific for elevated intracranial pressure requiring urgent intervention. Providers should consider further workup to evaluate for elevated intracranial pressure in headache patients with ONSD greater than or equal to 5.5mm. ObjectivesTo identify the best optic nerve sheath diameter (ONSD) cutoff among emergency department patients presenting with nontraumatic headache who require urgent intervention for the treatment of elevated intracranial pressure. To identify the best optic nerve sheath diameter (ONSD) cutoff among emergency department patients presenting with nontraumatic headache who require urgent intervention for the treatment of elevated intracranial pressure. MethodsA retrospective chart review was performed on 252 charts going back 2.5 years. Charts were extracted from the Emergency Department ultrasound database specifically searching patients who had ONSD measurements over the 2.5-year study period. Ultimately, 34 patients met criteria for inclusion in the study. Inclusion criteria consisted of patients 18 years of age, presented to the emergency department with headache, no documented recent history of head trauma, ONSD measured, and lateral decubitus lumbar puncture opening pressure recorded for the same visit. The patient records were reviewed for emergency department intervention and operative intervention. Discharge summary and clinic notes were reviewed for final diagnosis and outpatient management. Bilateral sonographic ONSDs were averaged and recorded for comparison to opening pressure and outcome. A receiver operator characteristic (ROC) curve was built to compare ONSD with patients who had elevated ICP requiring immediate intervention. A retrospective chart review was performed on 252 charts going back 2.5 years. Charts were extracted from the Emergency Department ultrasound database specifically searching patients who had ONSD measurements over the 2.5-year study period. Ultimately, 34 patients met criteria for inclusion in the study. Inclusion criteria consisted of patients 18 years of age, presented to the emergency department with headache, no documented recent history of head trauma, ONSD measured, and lateral decubitus lumbar puncture opening pressure recorded for the same visit. The patient records were reviewed for emergency department intervention and operative intervention. Discharge summary and clinic notes were reviewed for final diagnosis and outpatient management. Bilateral sonographic ONSDs were averaged and recorded for comparison to opening pressure and outcome. A receiver operator characteristic (ROC) curve was built to compare ONSD with patients who had elevated ICP requiring immediate intervention. ResultsIn our group of 34 patients, 9 were found to have elevated ICP requiring immediate intervention. 8 patients had idiopathic intracranial hypertension and 1 patient had venous sinus thrombosis. Among the immediate intervention group the average opening pressure was 46 cm H2O with an average ONS diameter of 6.2mm. The 5.0mm ONSD cutoff had a sensitivity of 100% and specificity of 46%. The 5.5mm ONSD cutoff had a sensitivity of 89% and specificity of 85%. The 6.0mm cutoff had a sensitivity of 67% and a specificity of 100%. In our group of 34 patients, 9 were found to have elevated ICP requiring immediate intervention. 8 patients had idiopathic intracranial hypertension and 1 patient had venous sinus thrombosis. Among the immediate intervention group the average opening pressure was 46 cm H2O with an average ONS diameter of 6.2mm. The 5.0mm ONSD cutoff had a sensitivity of 100% and specificity of 46%. The 5.5mm ONSD cutoff had a sensitivity of 89% and specificity of 85%. The 6.0mm cutoff had a sensitivity of 67% and a specificity of 100%. ConclusionsFor Emergency Department patients presenting with headache a sonographic ONSD greater than 5.5mm is both sensitive and specific for elevated intracranial pressure requiring urgent intervention. Providers should consider further workup to evaluate for elevated intracranial pressure in headache patients with ONSD greater than or equal to 5.5mm. For Emergency Department patients presenting with headache a sonographic ONSD greater than 5.5mm is both sensitive and specific for elevated intracranial pressure requiring urgent intervention. Providers should consider further workup to evaluate for elevated intracranial pressure in headache patients with ONSD greater than or equal to 5.5mm.