Citation

Young AM, Guilfoyle MR, Donnelly J, Scoffings D, Fernandes H, Garnett MR, Agrawal S, Hutchinson PJ. Pediatr. Res. 2016; 81(3): 443-447.

Affiliation

Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.

Copyright

(Copyright © 2016, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1038/pr.2016.165

PMID

27513519

Abstract

INTRODUCTION: The use of clinical markers to predict intracranial pressure (ICP) is desirable as a first line measure to assist in decision making as to whether invasive monitoring is required. Correlations between ICP and Optic nerve sheath diameter (ONSD) using CT and MRI have been observed in adult populations. However data on this modality in children is less well documented.

METHODS: ONSD was measured by independent observers and correlated with opening ICP at insertion of invasive monitoring probes in pediatric traumatic brain injury patients admitted to Addenbrookes Hospital between January 2009 and December 2013.

RESULTS: 36 patients with a mean age of 8.2 years were admitted to the PICU with a traumatic head injury and required invasive Neurosurgical monitoring. The median ICP was 18±10 mmHg (median+IQR), the median right ONSD was 5.6±2.5 mm and the left was 5.9±3.2 mm. The Intraclass correlation between observers was 0.91 (P<0.0001). The correlation of mean ONSD and max ONSD with ICP was 0.712 (P<0.0001) and 0.713 (P<0.0001), respectively. Area under ROC curve for both mean and max ONSD is 0.85 (95%CI 0.73-0.98).

CONCLUSION: Where pediatric patients present with an ONSD of over 6.1mm following a TBI, ICP monitoring should be implemented.

Language: en