• Stephanie Oberfoell, David Murphy, Andrew French, Stacy Trent, and David Richards.
• Denver Health Residency in Emergency Medicine, Denver, Colorado, USA.
• J Ultrasound Med. 2017 Aug 1; 36 (8): 1579-1584.

ObjectivesTo compare the degree of agreement of sonographic optic nerve sheath diameter (ONSD) measurements by ultrasound fellowship-trained and resident emergency medicine (EM) physicians.MethodsTen ultrasound fellowship-trained EM attending physicians from multiple institutions and 51 resident EM physicians at a single residency were enrolled to measure the ONSD using a computerized ruler on five separate still-frame sonograms of adult eyes that included the retrobulbar optic nerve. Descriptive and bivariate statistics for each ultrasound image were calculated to compare median ONSD measurements among groups. Intraclass correlation coefficients (ICCs) were calculated to estimate the inter-rater reliability.ResultsAlthough the median ONSD measurement of each image did not significantly differ between resident and ultrasound fellowship-trained EM physicians, we found greater variation in agreement of ONSD measurements by resident EM physicians (ICC 0.50; 95% confidence interval 0.25-0.89) than ultrasound fellowship-trained EM physicians (ICC 0.73; 95% confidence interval 0.44-0.96).ConclusionsAlthough both resident and ultrasound fellowship-trained EM physicians showed good inter-rater reliability of ONSD measurements, variation in agreement among ultrasound fellowship-trained EM physicians may be as wide as 0.44, suggesting that even in skilled hands, ultrasound measurement of the ONSD may not be as dependable a screening tool for elevated intracranial pressure as previously suggested in the literature.© 2017 by the American Institute of Ultrasound in Medicine.

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