الفهرس 
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Abstract
Ultrasound assessment ONSD has been assessed as a promising tool to aid in the diagnosis of elevated ICP. Optic nerve sheath is contiguous with the dura matter surrounding the brain and contains cerebrospinal fluid, which allows transmission of pressure from the cranium. A total of 99 patients presented and admitted to Mansoura University Emergency Hospital (MUEH) with TBI to evaluate the diagnostic accuracy of US ONSD for detecting elevated ICP. According to the cranial CT findings, the studied patients were equally divided into two groups: group 1: had no findings of increased ICP and group 2: had findings of increased ICP on CT brain. Most of the studied patients in group 1 and group 2 were males (78% vs. 68%) of middle age [(35.7 ± 9.4) vs. (34.1 ± 10.1) years old]. The most common mode of trauma was MVC; followed by RTA, FFH, and struggle without significant differences between both groups. GCS values were much higher (P <0.01) in group 1 (12.3± 3.11) vs. (8.1±2.79). Mild TBI prevailed (74%) in group 1, while severe type was the dominant form (70%) in group 2 with a high significant statistical difference between both groups. The clinical features of raised ICP had low specificity (38%), PPV (61.7%), and accuracy (69%) for diagnosis of raised ICP with high significant statistical difference (62% vs. 100%) towards group 2. The ONSD were much higher (P <0.01) in group 2 (6.493 ± 0.586 mm) than group 1 (3.93 ± 0.976 mm). The cutoff value of binocular mean ONSD for diagnosing raised ICP was > 5 mm with sensitivity of 100 %, specificity of 96%, and accuracy of 99%. The optimal cutoff value to predict mortality rate was > 6.8 mm with modest sensitivity and accuracy. While the optimal value to predict unfavorable GOS was >6.05mm with high sensitivity and accuracy.