Optic nerve sheath diameter as a predictor of altered mental status in drug intoxication patients

Abstract

Objectives: As far as we know, proposed the predictive performance of optic nerve sheath diameter measured (ONSD) from brain computed tomography to predict poor prognosis in drug intoxication patients. The aim of our study was to evaluate the predictive performance of ONSD for predicting mortality and admission in patients with altered mental status among drug intoxication patients. Method: We retrospectively enrolled patients with drug intoxication patients who underwent brain computed tomography due to altered mental status between January 2018 and December 2019. Two emergency physicians independently measured ONSD at 3 mm behind the globe in each patients. Statistical analysis including multivariate logistic regression analysis were yielded to estimate predictive performance. Results: A total of 18 patients (8.7%) were death and 57 patients (24%) were admitted out of 206 patients. ONSD was independently predictive factors for predicting mortality and admission. ONSD (cut-off = 4.35) had 69.05% sensitivity and 53.33% specificity with area under the receiver operating characteristic curve of 0.824 (95% CI = 0.803-0.927) for predicting mortality among drug intoxication patients while the ONSD (cut-off = 3.96) had 100% sensitivity and 51.5% specificity with area under the receiver operating characteristic curve of 0.824 (95% CI, 0.722-0.927) for predicting admission among patients. There were excellent inter- and intra-observer agreements for measuring ONSD on brain CT. Conclusion: ONSD was demonstrated as feasible predictive marker for predicting admission and mortality among drug intoxication patients with altered mental status. This information can help decision making for emergency physicians to provide prompt treatment in drug intoxication patients.