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Correlating optic nerve sheath diameter with opening intracranial pressure in pediatric traumatic brain injury.
Pediatr Res 2017; 81(3):443-447PR

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

Thirty-six patients with a mean age of 8.2 y were admitted to the Pediatric Intensive Care Unit (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 6.1 mm following a traumatic brain injury (TBI), ICP monitoring should be implemented.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27513519

Citation

Young, Adam M H., et al. "Correlating Optic Nerve Sheath Diameter With Opening Intracranial Pressure in Pediatric Traumatic Brain Injury." Pediatric Research, vol. 81, no. 3, 2017, pp. 443-447.
Young AM, Guilfoyle MR, Donnelly J, et al. Correlating optic nerve sheath diameter with opening intracranial pressure in pediatric traumatic brain injury. Pediatr Res. 2017;81(3):443-447.
Young, A. M., Guilfoyle, M. R., Donnelly, J., Scoffings, D., Fernandes, H., Garnett, M., ... Hutchinson, P. J. (2017). Correlating optic nerve sheath diameter with opening intracranial pressure in pediatric traumatic brain injury. Pediatric Research, 81(3), pp. 443-447. doi:10.1038/pr.2016.165.
Young AM, et al. Correlating Optic Nerve Sheath Diameter With Opening Intracranial Pressure in Pediatric Traumatic Brain Injury. Pediatr Res. 2017;81(3):443-447. PubMed PMID: 27513519.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Correlating optic nerve sheath diameter with opening intracranial pressure in pediatric traumatic brain injury. AU - Young,Adam M H, AU - Guilfoyle,Mathew R, AU - Donnelly,Joseph, AU - Scoffings,Daniel, AU - Fernandes,Helen, AU - Garnett,Mathew, AU - Agrawal,Shruti, AU - Hutchinson,Peter J, Y1 - 2016/08/11/ PY - 2016/02/19/received PY - 2016/06/16/accepted PY - 2016/8/12/pubmed PY - 2017/12/6/medline PY - 2016/8/12/entrez SP - 443 EP - 447 JF - Pediatric research JO - Pediatr. Res. VL - 81 IS - 3 N2 - 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: Thirty-six patients with a mean age of 8.2 y were admitted to the Pediatric Intensive Care Unit (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 6.1 mm following a traumatic brain injury (TBI), ICP monitoring should be implemented. SN - 1530-0447 UR - https://www.unboundmedicine.com/medline/citation/27513519/Correlating_optic_nerve_sheath_diameter_with_opening_intracranial_pressure_in_pediatric_traumatic_brain_injury_ L2 - http://dx.doi.org/10.1038/pr.2016.165 DB - PRIME DP - Unbound Medicine ER -