William Patten, MD
Pediatric Intensivist
Orlando Health - Arnold Palmer Hospital for Children, United States
Disclosure information not submitted.
Wendy Carcamo, MD, PhD
Orlando Health - Arnold Palmer Hospital for Children
Kissimmee, Florida
Disclosure information not submitted.
Bee Ben Khallouq
Biostatistician
Arnold Palmer Hospital for Children, United States
Disclosure information not submitted.
Greg Olavarria, MD
Pediatric Neurosurgeon
Orlando Health - Arnold Palmer Hospital for Children, United States
Disclosure information not submitted.
Samer Elbabaa, MD
Pediatric Neurosurgeon
Orlando Health - Arnold Palmer Hospital for Children, United States
Disclosure information not submitted.
Title: Optic Nerve Sheath Diameter: Surrogate for Intracranial Pressure in Pediatric Traumatic Brain Injury
INTRODUCTION/HYPOTHESIS: Severe Traumatic Brain Injury (TBI) is a Leading Cause of Mortality and Morbidity in Children. Elevated Intracranial Pressure (ICP) is a Risk Factor Associated with Poor Outcome. The Gold Standard for Monitoring Intracranial Pressure is by Invasive ICP Monitoring. The Aim of this Study was to Assess the Relationship of Optic Nerve Sheath Diameter (ONSD) on the Initial Head CT with Opening ICP and Management in Pediatric Patients After Traumatic Brain Injury.
Methods: We Conducted a Retrospective Study of Pediatric Patients Admitted to a Tertiary Care Pediatric Intensive Care Unit at a Pediatric Level 1 Trauma Center. Inclusion Criteria Included Severe Traumatic Brain Injury, ICP Monitor Placement with an Opening Pressure, And Initial Head CT. ONSD was Measured on the Initial Head CT According to Prior Literature, 3mm from the Posterior Orbit. The Principal Investigator Underwent Training and Instruction with a Pediatric Radiologist Regarding ONSD Measurement. ONSD was Measured 3 Times on each Orbit and the Mean of these 6 Measurements was Recorded. The Primary Outcome was the Correlation Between ONSD and Opening ICP.
Results: There were a Total of 48 Patients that Met Inclusion Criteria. Age Ranged from 1-18yo (Median 13yo). Initial Glasgow Coma Score Ranged from 3-14 (Median 5). ONSD Ranged from 4.7mm to 10.2mm (Mean 6.9mm). Initial Opening ICP Ranged from 2 mmhg to 100mmhg (Mean 19mmhg). There was a Positive and Statistically Significant Association Between ONSD on Initial Head CT and Opening ICP (R=0.62, P< 0.001). In Addition, ONSD Of 6.6 mm Demonstrated an 87% Sensitivity and 62% Specificity for ICP > 20mmhg, with a Positive Predictive Value of 70%.
Conclusions: ONSD on Initial Head CT Correlates with Opening ICP in Pediatric Patients. ONSD May Assist in Initial Management of Pediatric TBI.