The role of optic nerve sheath diameter and rotterdam computerized tomography scoring in predicting the severity of traumatic brain injury

Objective: To determine the predictive value of the optic nerve sheath diameter (ONSD) at distances 3 mm and 10 mm behind the posterior limit of the eyeball and of the initial Rotterdam CT Scoring (RCTS) scores in determining the severity and mortality in traumatic brain injury (TBI). Design: Retrospective study Setting: Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Antalya, Turkey Subjects: One hundred and eighty-two patients were included from January to December, 2017 Intervention: None Main outcome measure: Demographic and clinical data and computed tomography (CT) scans of the brain were record-ed. ONSD for each eye was measured on the initial CT scans. Bilateral ONSD was measured at distances 3 and 10 mm behind the posterior limit of the eyeball and RCTS scores were assessed on the same CT images. Results: The study included 182 patients [age: 43.68±19.65 years; 79.1% males; mean RCTS: 2.53±1.35; mortality: 14.3% (n=27)]. The median RCTS score was 4(1-6) mm in non-survi-vors vs. 2(1-6) mm in surviving patients (P<.001). The mortality rate for RCTS score of ≥4 was 40% (18/45). The mean ONSD values measured both at 3 mm and 10 mm distances were higher for lower Glasgow Coma Scale (GCS) scores (P=.001, P=.003, respectively). The mean ONSD values were higher for higher RCTS scores (P<.001). The receiver operat-ing curve analysis calculated the best ONSD cut off value to predict mortality as 5.0 mm (sensitivity: 80%; specificity: 78.46%) with an area under curve of 0.856 (95% CI: 79-92.1%). Conclusion: ONSD values along with RCTS and GCS scores enhance the prognostic performance and improve sensitivity while maintaining high specificity in predicting severe TBI and mortality. © 2020, Kuwait Medical Association. All rights reserved.