Noninvasive Methods Lack Accuracy for Identifying Increased Intracranial Pressure

Recognition of increased intracranial pressure (ICP) in severely head-injured patients is important but typically requires invasive monitoring. To determine the accuracy of noninvasive methods for detecting elevated ICP, researchers performed a systematic review and meta-analysis of studies that used invasive measurements as the gold standard to evaluate the diagnostic accuracy of head computed tomography (CT), physical exam findings, transcranial Doppler, or optic nerve sheath diameter in adult patients in the emergency department or intensive care unit.

Forty studies were included in the meta-analysis. The most common underlying conditions were traumatic brain injury and subarachnoid hemorrhage. The three physical exam findings studied — p…