Department of Radiology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara-Turkey.
Department of Emergency Medicine, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara-Turkey.
Ulus Travma Acil Cerrahi Derg. 2020 Sep;26(5):728-734. doi: 10.14744/tjtes.2020.13446.
Intracranial pressure (ICP) monitoring is of profound importance concerning prognosis and treatment among children with traumatic brain injury (TBI). Measurements of the optic nerve sheath diameter (ONSD) are one of the methods recommended for ICP monitoring. In this study, we aimed to evaluate the correlation of ONSD change in brain computed tomography (CT) with pediatric Glasgow Coma Score (pGCS) in the follow-up of pediatric cases with TBI, and also to evaluate the usability of the ONSD, which is the indicator of ICP.
The data of 921 pediatric patients who were admitted to the emergency department with head injury between January 2016 and January 2018 were retrospectively evaluated in this study. Age, gender, trauma type, brain CT finding, pGCS, type of intracranial hemorrhage (ICH), and isolated skull fracture (ISF) were investigated. The patients were evaluated in three groups based on CT findings: (i) patients with parenchymal brain injury, (ii) patients with ISF, and (iii) patients with normal brain CT results. The measurements of ONSD were performed using CT. Whether the ONSD measurement results of the patients were compatible with the clinical data was investigated.
The median age of the patients was 36 months (interquartile range [IQR] = 64) and 64.2% were male. The ONSD values and pGCSs of the patients with parenchymal injury were found to be significantly higher than patients with ISF and normal brain CT findings (p<0.05). The pGCSs showed a significant negative correlation with the first and second measurement results of ONSD (p<0.05). In groups undergoing control brain CT, ONSD levels in the second brain CT were found to be significantly high (p<0.05).
In the clinical follow-up, ONSD measurements are reliable and significant parameters when evaluated with brain CT findings and pGCSs. We think that repeated ONSD measurements will be useful in determining possible adverse effects of secondary injury, as well as in determining the severity of the trauma during admission.
颅内压（ICP）监测对颅脑损伤（TBI）患儿的预后和治疗具有重要意义。视神经鞘直径（ONSD）的测量是推荐的 ICP 监测方法之一。在这项研究中，我们旨在评估 TBI 患儿脑 CT 中 ONSD 变化与小儿格拉斯哥昏迷评分（pGCS）的相关性，并评估 ONSD 作为 ICP 指标的可用性。
本研究回顾性分析了 2016 年 1 月至 2018 年 1 月期间因头部外伤收入急诊科的 921 例儿科患者的数据。研究调查了年龄、性别、创伤类型、脑 CT 表现、pGCS、颅内出血（ICH）类型和孤立性颅骨骨折（ISF）。根据 CT 表现将患者分为三组：（i）实质脑损伤患者，（ii）ISF 患者，（iii）正常脑 CT 结果患者。使用 CT 测量 ONSD。研究调查了患者的 ONSD 测量结果是否与临床数据相符。
患者的中位年龄为 36 个月（四分位距 [IQR] = 64），64.2%为男性。与 ISF 和正常脑 CT 结果患者相比，实质损伤患者的 ONSD 值和 pGCS 显著更高（p<0.05）。pGCS 与 ONSD 的第一次和第二次测量结果呈显著负相关（p<0.05）。在进行对照脑 CT 的组中，第二次脑 CT 的 ONSD 水平显著升高（p<0.05）。
在临床随访中，ONSD 测量值与脑 CT 表现和 pGCS 一起是可靠和重要的参数。我们认为，重复进行 ONSD 测量将有助于确定继发性损伤的可能不良影响，并确定入院时创伤的严重程度。
