Optic nerve sheath diameter measurement for the paediatric patient with an acute deterioration in consciousness

Optic nerve sheath diameter measurement for the paediatric patient with an acute deterioration in consciousness

Reviewer: Lino Piotto, FASA

Authors & Journal: Ali A, McCreary DJ. 2023; Ultrasound J, 15(1):45.

Why the study was performed

The study aimed to explore the use of optic nerve sheath diameter (ONSD) measurement as a non-invasive diagnostic tool for assessing intracranial pressure (ICP) in paediatric patients who are experiencing an acute deterioration in consciousness. Elevated ICP is a critical concern in these cases and can be challenging to assess in children, especially without invasive procedures.

The motivation was to find a practical, quick, and less invasive method to assist healthcare professionals in monitoring these patients’ neurological status.

How the study was performed

Design: This was an observational study involving paediatric patients who presented with acute changes in consciousness.

Methods: The researchers measured the optic nerve sheath diameter using ultrasonography, which can detect changes in ICP based on the enlargement of the optic nerve sheath. The measurements of the ONSD were then compared with clinical markers of elevated ICP to assess their accuracy.

Participants: The study focused on children who showed signs of deteriorating consciousness, which could be indicative of increased ICP.

Optic nerve sheath diameter (ONSD) has been demonstrated to correlate closely with intracranial pressure (ICP) and an elevated measurement can detect raised ICP readily.

What the study found

The study found that ONSD measurement via ultrasound was a reliable tool for detecting signs of increased ICP in paediatric patients with acute deterioration in consciousness.

Correlation with increased ICP: The results showed that larger ONSD measurements were strongly associated with elevated ICP in these patients.

Accuracy: The technique was shown to have good sensitivity and specificity, making it a potentially effective method for rapid, pointof-care evaluation in paediatric emergency settings.

Relevance to clinical practice

Non-invasive diagnostic tool: The study’s findings suggest that ultrasonographic ONSD measurement can be used as a rapid, non-invasive alternative to other methods (for example, invasive ICP monitoring) for assessing increased ICP in children.

Clinical decision-making: It can help guide clinical decisions, especially in emergency settings where quick evaluation of ICP is critical.

Wider application: This technique could be useful in various paediatric clinical environments, including emergency departments, intensive care units, and even in settings with limited access to advanced imaging equipment.

Overall, the study highlights the potential of ONSD measurement as a non-invasive and easily accessible method to assess ICP in paediatric patients with deteriorating consciousness, offering significant clinical value in the management of these high risk patients.