Nihan Şık1, Emel Ulusoy1, Hale Çitlenbik1, Ali Öztürk1, Anıl Er2, Durgül Yılmaz1, Murat Duman3. 1. Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey. 2. Division of Pediatric Emergency Care, Department of Pediatrics, Dr. Behçet Uz Children's Hospital, Izmir, Turkey. 3. Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey. mduman@deu.edu.tr.
Abstract
PURPOSE: To determine the accuracy of bedside sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse (ETD) diameter ratios to predict space-occupying lesions (SOLs) or elevated intracranial pressure (ICP) in pediatric head trauma. METHODS: Children who presented to the emergency department with head trauma and underwent cranial computed tomography (CT) were enrolled and examined by ocular ultrasonography (US), and the ONSD was measured at 3 mm posterior to the globe and ETD were measured. Ratios of ONSD at 3 mm/ETD were calculated. All ONSD measurements and ratios were calculated from cranial CT images. RESULTS: Subjects with elevated ICP had increased ONSD measurements and ratios. To predict elevated ICP, the AUC for ONSD at 3 mm was 0.956 (95% CI 0.896-1). At a cut-off level of 5.1 mm, the sensitivity and specificity of ONSD 3 mm values for elevated ICP were 92.9% and 94.0%. For the ONSD 3 mm/ETD ratio, it was 0.980 (95% CI 0.959-1). At a cut-off level of 0.22, the sensitivity and specificity were 100% sensitivity and 88.0%. All sonographic ONSD measurements and ratios were significantly correlated with readings calculated from cranial CT images. CONCLUSION: Sonographic ONSD measurements and ratios were found to be quite sensitive to detect elevated ICP on cranial CT images. Additionally, there was a significant correlation between measurements calculated by ocular US and cranial CT scans. Bedside ocular US seems to be a promising and useful tool to determine ICP in children with head trauma.
PURPOSE: To determine the accuracy of bedside sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse (ETD) diameter ratios to predict space-occupying lesions (SOLs) or elevated intracranial pressure (ICP) in pediatric head trauma. METHODS: Children who presented to the emergency department with head trauma and underwent cranial computed tomography (CT) were enrolled and examined by ocular ultrasonography (US), and the ONSD was measured at 3 mm posterior to the globe and ETD were measured. Ratios of ONSD at 3 mm/ETD were calculated. All ONSD measurements and ratios were calculated from cranial CT images. RESULTS: Subjects with elevated ICP had increased ONSD measurements and ratios. To predict elevated ICP, the AUC for ONSD at 3 mm was 0.956 (95% CI 0.896-1). At a cut-off level of 5.1 mm, the sensitivity and specificity of ONSD 3 mm values for elevated ICP were 92.9% and 94.0%. For the ONSD 3 mm/ETD ratio, it was 0.980 (95% CI 0.959-1). At a cut-off level of 0.22, the sensitivity and specificity were 100% sensitivity and 88.0%. All sonographic ONSD measurements and ratios were significantly correlated with readings calculated from cranial CT images. CONCLUSION: Sonographic ONSD measurements and ratios were found to be quite sensitive to detect elevated ICP on cranial CT images. Additionally, there was a significant correlation between measurements calculated by ocular US and cranial CT scans. Bedside ocular US seems to be a promising and useful tool to determine ICP in children with head trauma.
Authors: Sophia D Lin; Kimberly R Kahne; Amira El Sherif; Kevin Mennitt; David Kessler; Mary J Ward; Shari L Platt Journal: Pediatr Emerg Care Date: 2019-04 Impact factor: 1.454