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Diagnostics
Protocol
Optic nerve sheath diameter sonography for the diagnosis of increased intracranial pressure: a systematic review and meta-analysis protocol
  1. Alex Koziarz1,
  2. Niv Sne2,
  3. Fraser Kegel2,
  4. Waleed Alhazzani3,
  5. Siddharth Nath1,
  6. Jetan H Badhiwala4,
  7. Timothy Rice5,
  8. Paul Engels6,
  9. Faidi Samir2,
  10. Andrew Healey7,
  11. Kamyar Kahnamoui8,
  12. Laura Banfield9,
  13. Sunjay Sharma1,
  14. Kesava Reddy1,
  15. Gregory W J Hawryluk10,
  16. Andrew W Kirkpatrick11,
  17. Saleh A Almenawer1
  1. 1 Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
  2. 2 Division of General Surgery and Trauma, McMaster University, Hamilton, Ontario, Canada
  3. 3 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  4. 4 Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
  5. 5 Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
  6. 6 Division of General Surgery, Trauma, and Critical Care, McMaster University, Hamilton, Ontario, Canada
  7. 7 Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
  8. 8 Division of General Surgery and Critical Care, McMaster University, Hamilton, Ontario, Canada
  9. 9 Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
  10. 10 Department of Neurosurgery and Neurology, University of Utah, Salt Lake City, Utah, USA
  11. 11 Department of Surgery and Critical Care, University of Calgary, Calgary, Canada
  1. Correspondence to Dr Saleh A Almenawer; dr_menawer{at}hotmail.com

Abstract

Introduction Increased intracranial pressure (ICP) is a significant neurological issue that may lead to permanent neurological sequelae. When evaluating patients with traumatic brain injury, it is crucial to identify those with high ICP in order to expedite ICP lowering measures and maintain adequate cerebral perfusion. Several measures are used to recognise patients with increased ICP including CT scan, MRI, ICP monitor, and lumbar puncture (LP). However, these tests can be invasive, associated with radiation exposure, contraindicated, or not readily available. Ultrasonography measurement of the optic nerve sheath diameter (ONSD) is proposed as a non-invasive and quick measure to identify high ICP. The aim of this systematic review and meta-analysis will be to examine the accuracy of ONSD sonography for increased ICP diagnosis.

Methods and analyses We will include published and unpublished randomised controlled trials, observational studies, and abstracts, with no publication type or language restrictions. Search strategies will be designed to peruse the MEDLINE, Embase, Web of Science, WHO Clinical Trials, ClinicalTrials.gov, CINAHL, and the Cochrane Library databases. We will also implement strategies to search grey literature. Two reviewers will independently complete data abstraction and conduct quality assessment. Included studies will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We will construct the hierarchical summary receiver operating characteristic curve for included studies and pool sensitivity and specificity using the bivariate model. We also plan to conduct prespecified subgroup analyses to explore heterogeneity. The overall quality of evidence will be rated using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Ethics and dissemination Research ethics board approval is not required for this study as it draws from published data and raises no concerns related to patient privacy. This review will provide a comprehensive assessment of the evidence on ONSD sonography diagnostic accuracy and is directed to a wide audience. Results from the review will be disseminated extensively through conferences and submitted to a peer-reviewed journal for publication.

PROSPERO registration number CRD42017055485.

Clinical trial number Trial registration number is NCT00783809.

  • optic nerve sheath diameter sonography
  • Increased Intracranial Pressure
  • severe head injury
  • ultrasound

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-016194

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    Footnotes

    • Contributors AK, NS, and SAA conceived and designed the protocol. AK, LB, and SAA designed the search strategy and piloted it across all relevant databases. AK, NS, FK, and SAA developed the review protocol, selection criteria, and risk of bias assessment. AK and SAA designed the data management and synthesis methodology. AK, NS, FK, WA, SN, JHB, TR, PE, FS, AH, KK, LB, SS, KR, GWJH, AWK, and SAA critically reviewed and collaborated in the discussion of the intellectual content of the manuscript.

    • Funding This research received no specific grant from any funding agency in the public, commercial, or not+for+profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.