Ultrasonographic optic nerve sheath diameter for predicting elevated intracranial pressure and clinical severity in children: a prospective observational study.

Elevated intracranial pressure (ICP) can complicate various neurological conditions in children and may result in fatal brainstem herniation. Early detection and management can prevent this fatal complication. This prospective observational study conducted over 18 months aimed to evaluate point-of-care ultrasound (POCUS) as a noninvasive, efficient method to detect elevated ICP in children aged less than 14 years. The primary objective of this study is to determine optic nerve sheath diameter (ONSD) values in children, measured by POCUS, and correlate them with the clinical severity of ICP. Secondary objectives include establishing age-specific ONSD values for diagnosing and predicting ICP severity, determining normal ONSD values from age-matched control groups, and estimating ONSD changes in response to hyperosmolar therapy. This study found a significant increase in ONSD in children with raised ICP compared to controls (5.63 mm vs. 4.35 mm), with consistent measurements across different locations. However, ONSD did not correlate with the clinical severity of ICP. While age moderately influenced ONSD in healthy children, it had no significant impact in those with raised ICP. The age-specific cut-off values for POCUS-measured ONSD (e.g., 4.91 mm for 1.5-10 years and 5.27 mm for 10-14 years) exhibited high sensitivity and specificity for detecting raised ICP. Furthermore, both hypertonic saline and mannitol effectively reduced ONSD, with no significant difference in their efficacy, suggesting both are viable options for managing raised ICP.

conclusionThis study establishes POCUS-measured ONSD as a reliable tool for detecting raised ICP in children. While more research is needed for age-specific norms and severity prediction, ONSD shows promise as a valuable adjunct in pediatric ICP management. WHAT IS KNOWN: • Optic nerve sheath diameter (ONSD) is a validated noninvasive marker for detecting intracranial hypertension in children. WHAT IS NEW: • ONSD does not correlate with the clinical severity of intracranial pressure, limiting its use as a quantitative stratification tool.