 Good morning. I'm Dr. R. Mahima Kale from Sivdevaraj Aras Academy of Higher Education and Research, Tamaka Kolar. Today, I'll be presenting my paper presentation on topic correlation between optic nerve sheet diameter and Rotterdam computer tomography scoring in traumatic brain injury. Thico authors are Dr. Rajeshwari Ma'am, Dr. Anil Kumar Saklecha Sir, Dr. Varshita Ma'am, Dr. Kalathuru Uhasai and Dr. Shantala Saukat. AIM to study the correlation between optic nerve sheet diameter and Rotterdam CT score in predicting outcome and prognosis in patients with traumatic brain injury on admission. Introduction in India and other developing nations, traumatic brain injuries are the main cause of morbidity, mortality, disability and socioeconomic losses. Optic nerve sheet diameter evaluated in CT imaging as well as Rotterdam CT score are proven independent predictors of outcome in patients with traumatic brain injury. Very few studies has correlated optic nerve sheet diameter on admission CT scan with Rotterdam CT score. Optic nerve sheet diameter measurement has lately become a substitute non-invasive technique for keeping track of intracranial pressure. Rotterdam CT score for prediction of outcome in traumatic brain injury is widely used for patient evaluation. In emergency room, optic nerve sheet diameter and Rotterdam CT score could be used as a preliminary charge tool as well as a way to decide if patients with traumatic brain injury require a subsequent CT scan and know the prognosis of patient. Methods. It is a hospital-based prospective study that included 90 patients. Study is performed on patients undergoing CT brain imaging for traumatic brain injury. Inclusion criteria. Patients above 18 years of age with traumatic brain injury are included. All patients making the inclusion criteria are included and CT will be performed in cement somatone, emotional 16 slice spiral CT with a slice thickness of 0.75 mm. Rotterdam CT score for all cases will be done and patients were divided into two groups. Those patients with score of 1, 2 and 3 were labelled as mild head injury and 4, 5, 6 were labelled as severe head injury. Optic nerve sheet diameter was measured according to the standard protocol that is 3 mm behind the posterior limit of the eye wall in axial plane using soft tissue. The diameter of both optic nerve sheet was measured and the mean was obtained. This is the CT scan axial section images that is showing how to measure the optic nerve sheet diameter. In this image, as you can see the optic nerve sheet diameter is measured 3 mm behind the posterior limit of the eye. And this is the case of severe traumatic brain injury and hence the optic nerve sheet diameter is 5.8 mm. Next coming to results, it is divided under these four headings that is the general demographic data, optic nerve sheet diameter measurement, Rotterdam CT score and the relation between severe brain injury and optic nerve sheet diameter. Coming to general demographic data, 90 traumatic head injury patients meeting the inclusion criteria were included. Out of 90 patients 66 per male that constituted to 73.3% and 24 were females that constituted to 26.7%. Mean age of the patient was 34.8 years plus or minus 13.8 years. The range is 18 to 75 years. Motor vehicle accident is the most common mode of injury that constituted to 72.2% followed by fall injury which is 20% and physical assault that is 7.8%. Optic nerve sheet diameter measurement. The mean optic nerve sheet diameter is 4.37 plus or minus 0.84 mm. The range is 3 to 6.5 mm. The mean optic nerve sheet diameter in the right eye was 4.39 mm and in the left eye was 4.35 mm. There was no statistical difference in optic nerve sheet diameter measurement in both eyes. Coming to Rotterdam CT score. Out of 90 patients 16 patients had score 1, 27 patients had score 2, 14 patients had score 3, 15 patients had score 4, 13 patients had score 5 and 5 patients had a score of 6. 57 patients that is 63.3% had mild head injury that is Rotterdam CT score of 1, 2 and 3 and 33 patients that is 36.7% patients had a severe head injury with Rotterdam CT score of 4, 5 and 6. Coming to relation between severe brain injury and optic nerve sheet diameter. According to Rotterdam CT score the patients are divided into mild and severe head injury patients. In mild head injury patients the mean of right optic nerve sheet diameter, left optic nerve sheet diameter and the overall mean optic nerve sheet diameter is the same that is 3.8 plus or minus 0.64 mm. In severe head injury cases the mean of right optic nerve sheet diameter is 5.3 plus or minus 0.66 mm and the mean of left optic nerve sheet diameter is 5.2 plus or minus 0.66 mm and the overall mean optic nerve sheet diameter is 5.2 plus or minus 0.66 mm. Coming to mean optic nerve sheet diameter, for score 1 it is 3.2 mm, for score 2 it is 3.9 mm, for score 3 it is 4.3 mm, for score 4 it is 4.8 mm, for score 5 it is 5.6 mm, for score 6 it is 5.9 mm. So in this ROC curve analysis we can see that the cutoff value of the optic nerve sheet diameter for the prediction of severity of traumatic brain injury was calculated. The best cutoff value of right optic nerve sheet diameter was found to be more than 4.5 mm with a sensitivity of 97% and specificity of 100%. In the same way for the left optic nerve sheet diameter the cutoff value was more than 4.6 mm with a sensitivity of 90.9% and specificity of 96.5%. And the overall mean optic nerve sheet diameter cutoff value was more than 4.4 mm with a sensitivity of 97% and specificity of 96.5%. So the correlation between optic nerve sheet diameter and the Rotterdam CT score was performed which showed a correlation coefficient value of 0.83 and a p value of 0.0001 which was statistically significant value and indicates positive relationship between the two parameters. Coming to discussion both Rotterdam CT score and optic nerve sheet diameter are the two independent parameters used to predict the outcomes in cases of traumatic brain injury. Very few studies were found where the Rotterdam CT score and the optic nerve sheet diameter are compared. In this regard we aim to evaluate the correlation between the optic nerve sheet measurement in initial CT scan with the Rotterdam CT score. CT is the preferred imaging modality in cases of head injury and is easily available in most of the centres. Based on the imaging findings and the Rotterdam CT score, the severity and prognosis of traumatic brain injury can be assessed. Rotterdam CT score is expressed as a score of 1 to 6 and a higher score indicates more severe head injury. Many studies consider Rotterdam CT score as an independent radiological prognostic tool. Raise intracranial pressure, second due to traumatic brain injury, is an indicator of poor prognosis. Timely diagnosis of raised intracranial pressure is crucial for management. Optic nerve sheet diameter measurement is an alternative indirect way of measuring intracranial pressure. In this study it was found that the Rotterdam CT score showed a positive correlation with optic nerve sheet diameter value. The Rotterdam CT score of 1, 2, 3 had a lower optic nerve sheet diameter value within the normal range whereas Rotterdam CT score of 4, 5, 6 had higher optic nerve sheet diameter value. The cut-off value of mean optic nerve sheet diameter derived from the ROC curve for the prediction of severity of brain injury is more than 4.4 mm. So coming to conclusion, CT optic nerve sheet diameter should be documented in each report of the initial CT scan of traumatic brain injury cases which may be an important radiological tool to assess severity of traumatic brain injury and to rule out the presence of increased intracranial pressure. These are my references. Thank you.