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Diagnostic Accuracy of Optic Nerve Sheath Diameter Using Ultrasonography for Raised Intracranial Pressure in

Gunaseelan Rajendran1, Sasikumar Mahalingam2, Anitha Ramkumar1

  • 1Department of Emergency Medicine and Trauma, Aarupadai Veedu Medical College and Hospital, Vinayaka Missions' Research Foundation (DU), Puducherry, India.

World Neurosurgery
|August 14, 2024
PubMed

Insights

Ultrasonography of the optic nerve sheath diameter (ONSD) is a highly accurate method for detecting increased intracranial pressure in children. This non-invasive technique aids in early diagnosis and treatment, preventing severe outcomes in pediatric patients.

Area of Science:

  • Pediatric critical care medicine
  • Neuro-ophthalmology
  • Medical imaging and diagnostics

Background:

  • Early detection of increased intracranial pressure (ICP) in pediatric patients is crucial for preventing morbidity and mortality.
  • Optic nerve sheath diameter (ONSD) measurement via ultrasound is a potential non-invasive tool for assessing ICP.

Approach:

  • A systematic review and meta-analysis synthesized data from 25 studies involving 1591 pediatric patients.
  • Evaluated the diagnostic accuracy (sensitivity and specificity) of ultrasound-measured ONSD for predicting elevated ICP.
  • Utilized invasive monitoring (external ventricular drain) and noninvasive measures as gold standards for ICP confirmation.

Key Points:

  • The pooled sensitivity for ONSD ultrasound in detecting increased ICP was 92% (95% CI: 86%-96%).
  • The pooled specificity was 89% (95% CI: 77%-96%), with a positive likelihood ratio of 8.6.
  • Ultrasound measurement of ONSD demonstrated high diagnostic accuracy in pediatric patients.

Conclusions:

  • Optic nerve ultrasonography is a precise and valuable diagnostic tool for pediatric patients with suspected increased ICP.
  • Routine ocular ultrasound for ONSD measurement is recommended to enhance diagnostic accuracy in pediatric ICP assessment.
  • This non-invasive method is applicable across diverse clinical scenarios and patient populations.
Abstract

Keywords:
ICPInfantsInvasive monitoringONSDOcular ultrasoundOptic nerve sheath diameterPediatricsRaised noninvasive monitoring

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