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Childs Nerv Syst. 2016 Oct;32(10):1779-85. doi: 10.1007/s00381-016-3068-4. Epub 2016 Sep 20.

The relationship between transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) and invasively measured ICP in children. : Part II: age-related ONSD cut-off values and patency of the anterior fontanelle.

Author information

1
Paediatric Neurosurgery Unit, Division of Neurosurgery, Faculty of Health Sciences, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa. llewesp@yahoo.com.
2
Trauma Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
3
Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa.
4
Paediatric Opthalmology Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
5
Paediatric Neurosurgery Unit, Division of Neurosurgery, Faculty of Health Sciences, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.

Abstract

PURPOSE:

To analyse the diagnostic accuracy of age-related optic nerve sheath diameter (ONSD) cut-off values in children for detecting raised intracranial pressure (ICP) and to assess the benefit of using patency of the anterior fontanelle in describing a different set of cut-off values.

METHODS:

The ONSD measurement was performed prior to invasive ICP measurement in children under general anesthesia. The diagnostic accuracy of the ONSD measurement was compared to ICP at thresholds of 20, 15, 10, and 5 mmHg. This was further analysed in children above and below the age of 1 year, with a subgroup analysis of age at 4 years, and assessment of the anterior fontanelle (AF) as a reliable physiological marker in part II of this study.

RESULTS:

Data from 174 children were analysed. In children ≤1 year old, the ONSD measurement with the best diagnostic accuracy for detecting ICP ≥ 20 mmHg was 5.16 mm, compared to 5.75 mm in children >1 year old (p < 0.001). In addition, patency of the anterior fontanelle (AF) was found to be a useful clinical marker for defining different ONSD cut-off values at ICP thresholds of 20, 15, 10 and 5 mmHg.

CONCLUSION:

Transorbital ultrasound measurement of the ONSD is a reliable non-invasive marker of ICP particularly at higher thresholds of 20 and 15 mmHg. Patency of the AF is a useful clinical marker for defining different ONSD cut-off values in children.

KEYWORDS:

ICP monitoring; Non-invasive; Optic nerve sheath diameter; Ultrasound

PMID:
27659820
DOI:
10.1007/s00381-016-3068-4
[Indexed for MEDLINE]

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