• Sangkil Lee, Yong Oh Kim, Ji Sun Baek, and Jeong-Am Ryu.
• Department of Neurology, ChungBuk National University Hospital, Cheongju, Republic of Korea.
• Crit Care. 2019 Feb 26; 23 (1): 65.

BackgroundWe evaluated the role of optic nerve sheath diameter (ONSD) using brain computed tomography (CT) in predicting neurological outcomes of patients with subarachnoid hemorrhage (SAH).MethodsThis was a retrospective, multicenter, observational study of adult patients with SAH admitted between January 2012 and June 2017. Initial brain CT was performed within 12 h from onset of SAH, and follow-up brain CT was performed within 24 h from treatment of a ruptured aneurysm. Primary outcome was neurological status at 6-month follow-up assessed with the Glasgow Outcome Scale (GOS, 1 to 5).ResultsAmong 223 SAH patients, 202 (90.6%) survived until discharge. Of these survivors, 186 (83.4%) manifested favorable neurological outcomes (GOS of 3, 4, or 5). In this study, the ONSDs in the group of patients with poor neurological outcome were significantly greater than those in the favorable neurological outcome group (all p < 0.01). Intracranial pressure (ICP) was monitored in 21 (9.4%) patients during the follow-up CT. A linear correlation existed between the average ONSD and ICP in simple correlation analysis (r = 0.525, p = 0.036). Analysis of the receiver  operating characteristic curve for prediction of poor neurological outcome showed that ONSD had considerable predictive value (C-statistics, 0.735 to 0.812). In addition, the performance of a composite of Hunt and Hess grade and ONSD was increasingly associated with poor neurological outcomes than the use of each marker alone.ConclusionsONSD measured with CT may be used in combination with clinical grading scales to improve prognostic accuracy in SAH patients.

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