Optic nerve sheath diameter trajectories and mortality in children with clinically relevant elevated intracranial...

The optic nerve sheath diameter (ONSD) measured by ultrasound has emerged as a significant noninvasive method for detecting elevated intracranial pressure (ICP), guiding timely interventions, and monitoring treatment response. Previous studies have shown that the baseline ONSD at admission is a prognostic indicator of mortality in adult patients with cerebrovascular events, traumatic brain injury, hepatic encephalopathy, and acute stroke. However, pediatric data on the dynamic changes in ONSD remain limited.

To study the association between within-48 hours admission dynamic ONSD changes and mortality in children with clinically relevant elevated ICP.

This single-institution prospective study was performed at a tertiary Children's Hospital in Vietnam, between November 2023 and August 2024. The primary outcome was in-hospital mortality rate. ONSD data were measured at admission, 24 hours, and 48 hours post-admission to pediatric intensive care unit (PICU). Linear mixed-effects models accounting for repeated measures within individuals were used to analyze the association between ONSD changes and in-hospital mortality.

A total of 69 PICU-admitted children with clinically relevant raised ICP were enrolled and included in the analysis. The median patient age was 6 years (interquartile range: 1-12), and males accounted for 54% of all patients. The in-hospital mortality rate in children with clinically relevant raised ICP was 23.2%. Traumatic brain injury, sepsis-associated encephalopathy, and septic shock were the main causes of death in this cohort. Linear mixed-effects analysis showed that dynamic variability in ONSD values upon PICU admission and during the first 48 hours later correlated significantly with increased mortality. Nonsurvivors had a 5.3% increase in the mean ONSD at 48 hours compared to baseline levels, while the survivors showed a 5.6% reduction in ONSD.

Serial ultrasound-based ONSD measurements within 48 hours of admission better predicted mortality than baseline data in critically ill children, offering a practical, noninvasive tool for early prognosis in elevated ICP.