OBJECTIVE: In Trauma brain injury (TBI) patients, early detection and subsequent prompt treatment of elevated intracranial pressure (ICP) is a challenge in the pre-hospital setting, as physical examination is limited in comatose patients, and invasive device placement not possible. The aim of this study was to evaluate the quality and feasibility of Optic Nerve Sheath Diameter (ONSD) measurements obtained during the prehospital management of TBI patients.
METHODS: Prospective, observational study of 23 moderate and severe TBI patients during pre-hospital medical care. The primary endpoint was the quality of ONSD measures expressed as the percentage of ONSD validated by the experts. Secondary endpoints was the feasibility of ONSD measures as the percentage of ONSD performed, the assessment by operators of ease and duration to perform.
RESULTS: Ultrasounds ONSD was performed in 19 (82%) patients and 80% of ONSD measures were validated by the experts. The ONSD measures were possible in 15 (79%) cases. The physicians have assessed the ease of use at 8 [2.5-8] on 10 for and the median time to obtain ONSD was 4 min (IQR [3-5]). ONSD measurement was performed in 12 (63%) cases during the transport and in 7 (37%) cases on scene, with 58% (n = 7) and 71% (n = 5) validated ONSD respectively. The success rate in the helicopter was 43% compared to 80% in the ambulance.
CONCLUSION: This study shows that it is feasible to obtain high quality ONSD measurements in the management of prehospital TBI patients. A randomized study evaluating the usefulness of ONSD to guide management of TBI in the prehospital phase may be of great interest.