The value of optic nerve sheath measurement in patients presenting to the emergency department with hypertensive crisis

To evaluate whether bedside ultrasonographic measurement of optic nerve sheath diameter (ONSD) can assist in the diagnosis of hypertensive emergency and predict hospitalization in patients presenting to the emergency department (ED) with hypertensive crisis. This prospective observational study enrolled adult patients presenting with systolic BP > 180 mm Hg and/or diastolic BP > 120 mm Hg. ONSD was measured on admission and repeated after blood pressure was reduced to target levels. Diagnostic performance was assessed using ROC analysis. A total of 112 patients with hypertensive crisis were included, and 22.3% (n = 25) were diagnosed with hypertensive emergency. The mean ONSD in these patients (5.99 ± 0.65 mm) was significantly higher than in those with hypertensive urgency (5.11 ± 0.57 mm) (P < .001). Among 31 hospitalized patients, the mean ONSD (5.83 ± 0.71 mm) was also significantly higher than in those not hospitalized (5.11 ± 0.57 mm) (P < .001). ROC analysis showed good diagnostic performance for predicting hypertensive emergency, with the optimal ONSD cutoff identified as 5.8 mm (sensitivity: 68%, specificity: 93.1%, +LR: 9.86, -LR: 0.34). ONSD measurement is a rapid, noninvasive tool that may aid in early identification of hypertensive emergency and in predicting hospital admission. Its routine use in the ED could facilitate timely intervention and decision-making.