Valor prognóstico das medidas da bainha do nervo óptico na tomografia admissional de pacientes vítimas de traumatismo craniano moderado e grave

Abstract

BACKGROUND: Brain Computed Tomography (CT) is a essential diagnostic test to evaluate traumatic brain injury (TBI) patients. The optic nerve sheath (ONS) has been increasingly studied for the assessment of intracranial hypertension in traumatic brain injury (TBI) patients. The aim of this study was to evaluate different measures in the ONS as CT prognostic tools. METHODS: A retrospective cohort study was conducted by including patients with moderate and severe TBI admitted to the Intensive Care Unit between April and September 2018. ONS diameters, ratios between then and transverse diameter of the eyeball and ONS cross-sectional areas were calculated on admission CT at 3mm and 10mm from the eyeball, resulting in ONSD-3, ONSD-10, NER-3, NER-10, ONSA-3 and ONSA-10. The association between measurements and hospital mortality was investigated. A combined secondary outcome was defined as craniotomy within 5 days and/or death. RESULTS: Eighty one patients were included. Mean age was 36.3 +/- 15.8 years. 93% were men. 41% underwent craniotomy. Hospital mortality was 41%, while 72% had a combined outcome. None of the CT variables were significantly associated with hospital mortality. Craniotomy was a protective factor. Only ONSD-10 and NER-10 presented a significant association with the combined outcome (p = 0.03 and 0.005, respectively). In the subgroup of non -operated patients, ONSD-10 and NER-10 demonstrated independent prognostic value for hospital mortality, with cut-off values of ONSD-10 > 4.3mm (AOR = 14.24, p = 0.03) and NER-10 > 0.19 (AOR = 24.87, p = 0.03). CONCLUSION: The ONSD-10 and NER-10 measurements showed a better association with prognosis compared to measurements taken at 3mm, as well as other tomographic parameters for patients with moderate and severe TBI.