Abstract
Background : The optic nerve sheath diameter (ONSD) has been shown to increase within seconds of raised ICP, which can be measured by ultrasound. Hence, ONSD measurement can be potentially used to indirectly monitor elevated ICP. Methods : A prospective blinded observational study of all children (2-12 years) admitted to PICU undergoing ICP monitoring using intra parenchymal catheter was conducted in PGIMER, Chandigarh from November 2016 to August 2017. The ONSD from both eyes was measured using a 7.5 MHz ultrasound probe on closed eyelids. Horizontal and vertical diameters of both the optic nerves were measured and averages calculated. Repeated measurements were taken at least 3 hours apart. Observations who had measured ICP ≥20 mm Hg at the point of time were included as cases and with measured ICP ≤ 15 mm Hg were included as controls. Results : During the study period, of the total 25 children assessed for eligibility, 21 were enrolled. The median age of the cohort was 70 months. A total 95 observations were taken and the median observations per patient were 3. The total number of the observations included as cases and controls were 65 and 30 respectively. The median ICP was 27 and 7 for observations included as case and controls respectively. Compared to controls, the case group had significantly higher mean right eye ONSD (5.58±0.56 mm vs.4.08±0.55 mm, p<0.0001), mean left eye ONSD (5.61±0.66 mm vs.4.08±0.60 mm, p<0.0001) and mean binocular ONSD (5.60±0.60 mm vs.4.08±0.57 mm, p<0.0001). The spearman rank correlation coefficient of binocular ONSD and ICP was 0.71 (p<0.0005) demonstrating a significant positive correlation. Conclusion : This study demonstrates a strong correlation in between intra-parenchymal measurements of ICP with ONSD measurements and provides support for the use of ONSD measurements as a noninvasive test for elevated ICP.
Published Version
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