Correlation between optic nerve sheath diameter and Rotterdam computer tomography scoring in pediatric brain injury

Pediatric head trauma is the most common presentation to emergency departments. Increased intracranial pressure (ICP) may lead to secondary brain damage in head trauma and early diagnosis of increased ICP is very important. Measurement of optic nerve sheath diameter (ONSD) is a method that can be used for determining increased ICP. In this study, we aimed to evaluate the relationship between optic nerve sheath diameter (ONSD) and Rotterdam computer tomography scores (RCTS) in pediatric patients for severe head trauma.

During January 2017-April 2018, medical records and imaging findings of children aged 0-18 years who underwent computed tomography (CT) imaging for head trauma (n=401) and non-traumatic (convulsions, respiratory disorders, headache) (n=255) complaints, totally 656 patient were evaluated retrospectively. Patients' age, sex, presentation and trauma type (high energy-low energy) were identified. Non-traumatic patients with normal cranial CT findings were considered as the control group. CT findings of traumatic brain injury were scored according to Rotterdam criteria. Patients were divided into groups according to their age as follows: 0-3 years, 3-6 years, 6-12 years and 12-18 years.

In our study, tomographic reference measurements of the ONSD in pediatric cases were presented according to age. There was a statistically significant difference between ONSD of severe traumatic patients and the control group. Correlation between RCTS and ONSD was determined and age-specific cut-off values of ONSD for severe traumatic scores (score 4-5-6) were presented.

In our study, reference ONSDs of the pediatric population for CT imaging was indicated. Our study also showed that ONSD measurement is a parameter that can be used in addition to the RCTS to determine the prognosis of the patient in severe head trauma, by reflecting increased intracranial pressure.