Ultrassonografia da bainha do nervo óptico na detecção de sinais sugestivos de hipertensão intracraniana em pacientes de trauma cranioencefálico grave

Abstract

Introduction: Intracranial hypertension (ICH) is a critical neurological condition characterized by an abnormal increase in pressure within the cranial vault, which may result in severe and often fatal neurological complications. Given the need for less invasive, accessible, and effective methods for monitoring intracranial pressure (ICP), the development and validation of tools that support early diagnosis and clinical management of ICH are essential. Objective: To analyze the use of optic nerve sheath ultrasonography (ONSU) in detecting signs of ICH in patients with severe traumatic brain injury (TBI) in the state of Sergipe. Method: This is a prospective cohort study conducted at the Urgency Hospital. A total of 119 patients diagnosed with severe TBI were included, admitted to the emergency department between November 2024 and April 2025, within 12 hours after severe TBI, who underwent at least one cranial computed tomography (CT) scan—mandatory at hospital admission—and had optic nerve sheath diameter (ONSD) measurement performed at admission. Clinical and sociodemographic variables were collected from hospital admission at HUSE until hospital discharge. To assess the performance of ONSU in estimating signs of ICH, the area under the curve (AUC) was used to measure its discriminative ability. Univariate analyses were performed to identify factors associated with the presence of CT-evaluated signs of ICH. Results: ICH was identified by CT in 65.55% of patients with severe TBI. The most frequent CT findings included traumatic subarachnoid hemorrhage (34.45%), subdural hematoma (25.21%), and cerebral contusion (21.85%), with a predominance of Marshall classification diffuse injury type II (68.12%). Mean ONSD values were slightly higher in the ICH group (4.01 ± 0.80 mm) compared to the nonICH group (3.86 ± 0.55 mm), with no statistically significant difference (p = 0.3641). Serial ONSD measurements during the first 72 hours of hospitalization showed a progressive and statistically significant increase compared to baseline values (p < 0.001). Higher mean ONSD values were observed among patients who died, although without statistical significance. A clinical cutoff value of 6.0 mm demonstrated high sensitivity (88.5%) for identifying signs suggestive of ICH. Conclusion: ONSD increased over the course of clinical evolution, with a trend toward higher values in patients with greater neurological severity. Despite regular performance in identifying signs of ICH at admission, ONSU appears to be a useful complementary and noninvasive tool for initial screening and monitoring of patients with severe TBI.