Optic nerve sheath diameter measurement using point-of-care ultrasound to assess intracranial pressure of adult patients with traumatic brain injury in resource-limited setting

Background: Traumatic brain injury is a disease with high mortality partially from increased intracranial pressure including in the emergency department. Neuroimaging and intracranial pressure monitoring are limited in resource-limited settings. Optic nerve sheath diameter measurement to assess intracranial pressure indirectly using point-of-care ultrasound is appealing in diagnostics and decision-making.Objectives: We plan to evaluate the utility of point-of-care ultrasound of optic nerve sheath diameter and its role in traumatic brain injury patients.Materials and Methods: Optic nerve sheath diameter measurement was performed at presentation, postoperatively and 24 h later by trained residents. The procedure was repeated if any change in clinical status was observed. Clinical data and demographics were recorded and reviewed.Results: A total of 50 patients were enrolled. Twenty-one patients underwent neurosurgical intervention. Three patients died in hospital. Eighteen patients had optic nerve sheath diameters less than 5 mm, 20 patients had optic nerve sheath diameter between 5 mm and 6 mm, and 12 patients had optic nerve sheath diameter > 6 mm. In 2 patients with changes in clinical condition, the repeat optic nerve sheath diameter assessment showed an increase in optic nerve sheath diameter.Conclusion: Despite limitations, trained healthcare providers could assess and measure optic nerve sheath diameter. Longer training time and quality assurance are needed to appreciate the impact.