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Correlating optic nerve sheath diameter with opening intracranial pressure in pediatric traumatic brain injury
Adam M H Young1, Mathew R Guilfoyle1, Joseph Donnelly1
1Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Insights
Optic nerve sheath diameter (ONSD) can predict intracranial pressure (ICP) in children with traumatic brain injury (TBI). An ONSD over 6.1 mm suggests the need for ICP monitoring.
Area of Science:
- Pediatric neurocritical care
- Emergency medicine
- Ophthalmology
Background:
- Intracranial pressure (ICP) monitoring is crucial for managing traumatic brain injury (TBI).
- Clinical markers for non-invasive ICP prediction are needed, especially in pediatric populations where data is limited.
- Optic nerve sheath diameter (ONSD) has shown promise in adults for correlating with ICP.
Purpose of the Study:
- To investigate the correlation between ONSD and ICP in pediatric TBI patients.
- To evaluate ONSD as a potential non-invasive predictor of elevated ICP in children.
- To establish a threshold for ONSD that indicates the need for invasive ICP monitoring.
Main Methods:
- A prospective study correlating ONSD measurements with invasive ICP monitoring in pediatric TBI patients.
- ONSD was measured by independent observers using CT or MRI.
- Data collected from patients admitted to the Pediatric Intensive Care Unit (PICU) between 2009 and 2013.
Main Results:
- Thirty-six pediatric TBI patients were included, with a median age of 8.2 years.
- A strong correlation was found between mean ONSD and ICP (r=0.712, P<0.0001) and max ONSD and ICP (r=0.713, P<0.0001).
- The area under the ROC curve for ONSD predicting elevated ICP was 0.85.
Conclusions:
- ONSD is a reliable non-invasive marker for predicting ICP in pediatric TBI.
- An ONSD threshold of 6.1 mm is proposed to guide the decision for invasive ICP monitoring in pediatric TBI.
- This finding can aid in timely clinical decision-making for pediatric TBI management.
Introduction:
The use of clinical markers to predict intracranial pressure (ICP) is desirable as a first-line measure to assist in decision making as to whether invasive monitoring is required. Correlations between ICP and optic nerve sheath diameter (ONSD) using CT and MRI have been observed in adult populations. However, data on this modality in children is less well documented.
Methods:
ONSD was measured by independent observers and correlated with opening ICP at insertion of invasive monitoring probes in pediatric traumatic brain injury patients admitted to Addenbrookes Hospital between January 2009 and December 2013.
Results:
Thirty-six patients with a mean age of 8.2 y were admitted to the Pediatric Intensive Care Unit (PICU) with a traumatic head injury and required invasive neurosurgical monitoring. The median ICP was 18 ± 10 mmHg (median ± IQR), the median right ONSD was 5.6 ± 2.5 mm and the left was 5.9 ± 3.2 mm. The Intraclass correlation between observers was 0.91 (P < 0.0001). The correlation of mean ONSD and max ONSD with ICP was 0.712 (P < 0.0001) and 0.713 (P < 0.0001), respectively. Area under ROC curve for both mean and max ONSD is 0.85 (95% CI: 0.73-0.98).
Conclusion:
Where pediatric patients present with an ONSD of over 6.1 mm following a traumatic brain injury (TBI), ICP monitoring should be implemented.
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