Background. Raised intracranial pressure (ICP) is a life-threatening complication of traumatic brain injury, particularly among road traffic accident (RTA) victims. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) and the ONSD/eyeball transverse diameter (ETD) ratio has emerged as a promising non-invasive screening method. However, limited research – especially in low-resource or regional Indian settings – has evaluated their correlation with validated CT-based scoring systems. Additionally, trauma-specific ONSD cut-off values and diagnostic performance metrics such as ROC analysis remain underexplored. Aim. To assess the correlation between ultrasonographic ONSD, ONSD/ETD ratios, and Rotterdam CT scores (RCTS) in patients with suspected raised ICP following RTA-related head injuries. Methods. In this cross-sectional study, 60 RTA patients with suspected elevated ICP were included. Patients with orbital pathology or those who declined consent were excluded. ONSD and ETD were measured using a Voluson S8 ultrasound machine. RCTS was calculated from non-contrast CT brain scans using a Siemens SynGo Top 128-slice CT scanner. Pearson correlation was used to analyze associations. Results. A strong positive correlation was observed between ONSD and RCTS (r = 0.82), and between ONSD/ETD ratios (right: r = 0.82; left: r = 0.76; mean: r = 0.80) and RCTS. ETD showed a weak inverse correlation with RCTS (r = –0.26). No significant associations were found between RCTS and age or gender. Conclusion. ONSD and ONSD/ETD ratios correlate strongly with CT-based indicators of raised ICP, suggesting their value as non-invasive screening tools. However, due to the absence of gold standard ICP monitoring and diagnostic accuracy data, findings should be interpreted cautiously. Further studies are needed to validate cut-off values and clinical applicability.
Aram et al. (2025) studied this question.