The retrospective analysis of the patients who presented with head trauma to the emergency department and the relationship between the measured optic nerve sheath diameter values and clinical findings

INTRODUCTION: The aim in this study, retrospectively evaluate the patients with head trauma who werea dmitted to the Emergency Department of Afyonkarahisar Health Sciences University Medical School Hospital and determining whether there is a relationship between clinical and radiological findings with the measurements of optic nevre sheath diameter (ONSD) evaluated by computerized cranial tomography (CCT). MATERIAL AND METHOD: A retrospective study was performed on 483 patients who were admitted to the Emergency Department of Afyonkarahisar Health Sciences University Medical School Hospital and diagnosed as head trauma. Patients who were found to have cranial tomography from patients aged 18 years and over who were diagnosed with head trauma using hospital automation system and patient file information were identified and patients who met the inclusion criteria were selected. Patients under 18 years of age, orbital and sphenoid bone injury were detected by tomography, intracranial and intraorbital masses were detected, tomography could not be reached, presence of hyperthyroidism causing exophthalmos, optic nerve and eye disease affecting the orbit were not included in the study. Demographic and head trauma related features of the patients, computerized cranial tomography images and characteristics of the patients, Glasgow Coma Scores (GCS), Rotterdam CT scores (RCS) were determined and the data were recorded in the data collection form. The patients were divided into two groups as normal CCT and those with pathological CCT (presence of fractures, hemorrhage, edema and shift). With similarly neurological examination, patients were classified into two groups as GCS:13-15 and GCS:3-12 traumatic brain injury according to the literature. Patients were divided into 2 groups according to RCS results RCS: 1-2 and RCS: 3-6. The patient's CCT axial section was evaluated and optic nevre sheath diameter measurements were performed from the 3 mm proximal part of the optic disc in the section where the optic nevre could be best visualized and recorded in mm. In the same cross-section and from the retina to the retina, the eyeball transverse diameter (ETD) measurements were performed at the widest position and then ONSD/ETD index calculation was performed. Statistical Package for Social Sciences (SPSS) for Windows 23.0 (IBM) was used for statistical analysis of the data obtained in the study. FINDINGS: During the study period, the total number of patient visits to the emergency department was 155.961, of which 3844 (2.46%) were patients who were exposed to trauma. Of these patients, 1242 (0.79%) had head trauma. The study included 483 patients. 309 (64%) of the patients were male and 174 (36%) were female. Of the patients, 157 (32.5%) were in the age range of 18-29, 258 (53.4%) were 30-64 and 68 (14.1 %) were in the 65 and over age range. In the etiological evaluation, 52.0% of the patients had in-car traffic accident, 12.2% had out-car traffic accident, 10.1% had a fall from a height, 9.1 % had a fall on the flat flor and 16.6% had other reasons. In CCT evaluation; 51 (10.5%) pathologic and 432 (89.5 %) normal CCTs were detected. The most common pathologies were the fractures seen in 33 patients and bleeding in different localizations in 25 patients. There was no significant difference trauma mechanisms between groups in terms of gender (P> 0.05). According to the neurological examination GCS: 13-15 and GCS: 3-12 as divided into at two groups of patients, RCS, in the left and right eyes ONSD, in left and right eye ONSD / ETD index values were statistically significant between the groups (p=0,000, p=0,000, p=0,000, p=0,000, p=0,000, respectively). When the patients were divided into two groups according to their mortality and CT according to the presence of pathology, the difference was statistically significant in terms of GCS, RCS, in the right and left eyes ONSD, in the right and left eyes ONSD / ETD index values (p=0,000, p=0,000, p=0,000, p=0,000, p=0,000, respectively). According to the correlation analysis results; there was a statistically significant and negative relationship between GCS score with, RCS (r=-0.689; p=0.000), right eye ONSD (r=-0.182; p=0.000), left eye ONSD (r=-0.244; p=0.000), right eye ONSD / ETD index (r=-0.223; p=0.000) and left eye ONSD / ETD index (r=-0.280; p=0.000) values. When GCS, RCS, right and left eye ONSD, right and left eye ONSD / ETD index values were compared between RCS: 1-2 and RCS: 3-6 groups, the difference between groups was statistically significant (p=0,000, p=0,000, p=0,000, p=0,000, p=0,000, respectively). According to the results of ROC analysis, the diagnostic value of mortality bilateral optic nerve sheath diameter was found to be statistically significant (p<0.05). While the power to explain the mortality was 84.0 % for the left eye, it was 78.5% for the right eye. For the right eye ONSD, the sensitivity of cut-off at 4.785 was 83.3 % and the specificity was 57.1%. For the left eye ONSD, sensitivity of cut-off at 5.15 was 91.7% and specificity as 68.2%. CONCLUSION: In our study, intracranial pressure increase in patients with head trauma was demonstrated with CT-mediated ONSD and ONSD/ETD index help. A negative relationship was found between GCS with ONSD and ONSD/ETD index. Intracranial hemorrhage, fractures such as pathological CT, and mortal patients, ONSD and ONSD/ETD index values are increasing. Rotterdam CT scores determined by CT pathologies are correlated with the results of ONSD and ONSD/ ETD index. The ONSD/ETD index ratios calculated by CTs taken at the patient admissions in Emergency Services may provide important information in evaluating the increase in intracranial pressure. The results obtained suggest that the necessary treatment fastly approaches should be applied in patients with ONSD and ONSD / ETD index increase. It is thought that some of the evaluations made in ourstudy can contribute to literature. Keywords: Head injury, intracranial pressure, optic nerve sheath diameter, computerized cranial tomography