Fernando SM, et al. - Researchers performed this systematic review and meta-analysis of 40 studies representing over 5,100 individuals to summarize and compare the precision of physical examination, computed tomography (CT), sonography of the optic nerve sheath diameter (ONSD), and transcranial Doppler pulsatility index (TCD-PI) for the diagnosis of elevated intracranial pressure (ICP) in patients with critical illness. Of physical examination signs, pooled sensitivity and specificity for increased ICP were 28.2% and 85.9% pupillary dilation, respectively; 54.3% and 63.6% for posturing; and 75.8% and 39.9% for Glasgow coma scale of ≤ 8. Among CT findings, sensitivity and specificity were 85.9% and 61.0% for compression of basal cisterns, respectively; 80.9% and 42.7% for any midline shift; and 20.7% and 89.2% for midline shift of ≥ 10 mm. The pooled area under the ROC curve for ONSD sonography was 0.94. Patient level data from studies using TCD-PI demonstrated poor performance for detecting raised ICP. Overall, the absence of any one physical examination feature is not sufficient to rule out elevated ICP. Significant midline shift could be indicative of elevated ICP; however, the absence of shift cannot rule it out. ONSD sonography might have use, but further studies are warranted, according to the researchers. Suspicion of elevated ICP may require treatment and transfer, irrespective of individual non-invasive tests.