Measuring optic nerve sheath diameter in children: a simple ultrasound protocol for ICP assessment

Area of Science:

• Pediatric critical care medicine
• Neurocritical care
• Diagnostic imaging

Background:

• Elevated intracranial pressure (ICP) is a critical concern in pediatric traumatic brain injury (TBI).
• Invasive ICP monitoring, the gold standard, has limitations in pediatric cases.
• Non-invasive alternatives are needed for managing moderate TBI without direct ICP monitoring.

Purpose of the Study:

• To synthesize current evidence on optic nerve sheath diameter (ONSD) measurement using point-of-care ultrasound (POCUS) in children.
• To highlight the diagnostic potential and limitations of ONSD as a non-invasive ICP assessment tool.
• To support pediatric intensivists in applying ONSD for improved clinical decision-making in pediatric TBI.

Main Methods:

• Review and synthesis of existing literature on ONSD measurement in pediatric populations.
• Analysis of ONSD as a surrogate marker for ICP, utilizing cerebrospinal fluid (CSF) dynamics.
• Evaluation of methodological considerations and limitations of POCUS-based ONSD assessment.

Main Results:

• ONSD measurement via POCUS is a simple, rapid, and repeatable technique.
• ONSD shows diagnostic potential for detecting elevated ICP in pediatric TBI.
• Current clinical adoption is limited by a lack of standardized guidelines and normative data.

Conclusions:

• ONSD measurement is a promising non-invasive tool for assessing ICP in pediatric TBI.
• Further research is needed to establish standardized guidelines and normative data for pediatric ONSD.
• Implementing ONSD can enhance clinical decision-making and prognostic evaluation in pediatric TBI management.