Department of Emergency Medicine and Trauma, Aarupadai Veedu Medical College and Hospital, Vinayaka Missions' Research Foundation (DU), Puducherry, India.
Department of Emergency Medicine and Trauma, Aarupadai Veedu Medical College and Hospital, Vinayaka Missions' Research Foundation (DU), Puducherry, India; Department of Emergency Medicine, Sri Lakshmi Narayana Medical Science, Medical College and Hospital, Puducherry, India.
World Neurosurg. 2024 Oct;190:e1000-e1017. doi: 10.1016/j.wneu.2024.08.052. Epub 2024 Aug 12.
Detecting increased intracranial pressure early in pediatric patients is essential, as early initiation of therapy prevents morbidity and mortality. The objective of this study was to determine the diagnostic accuracy of the optic nerve sheath diameter (ONSD) measured via ultrasound for the prediction of increased intracranial pressure.
Four databases, namely, PubMed, EMBASE, Scopus, and CINAHL, were searched for this systematic review and meta-analysis. The study's predefined inclusion criteria considered diagnostic accuracy, cross-sectional, prospective observational, and retrospective studies with a focus on children with elevated intracranial pressure from causes such as traumatic brain injury and cerebral edema, the diagnostic accuracy of the optic nerve sheath diameter measured using ultrasound was assessed. The primary outcome measures included sensitivity and specificity. The study included invasive monitoring (external ventricular drain) and noninvasive measures as the gold standards for increased intracranial pressure. Two authors extracted and reviewed the data. Baseline data, outcome measures, and diagnostic accuracy data were extracted.
Twenty-five studies with 1591 patients and 3143 ONSD measurements via ultrasound were analyzed. The pooled sensitivity and specificity of the ONSD measured via ultrasound for the prediction of increased intracranial pressure were 92% (86%-96%) and 89% (77%-96%), respectively. The pooled positive and negative likelihood ratios were 8.6 and 0.08, respectively.
Optic nerve ultrasonography stands out as a precise and valuable diagnostic tool applicable across diverse patient populations and clinical scenarios. We recommend routine ocular ultrasound for optic nerve sheath diameter measurement in pediatric patients to increase the accuracy of diagnosing increased intracranial pressure.
早期检测小儿颅内压升高至关重要，因为早期开始治疗可预防发病率和死亡率。本研究的目的是确定经超声测量视神经鞘直径（ONSD）预测颅内压升高的诊断准确性。
本系统评价和荟萃分析检索了四个数据库，即 PubMed、EMBASE、Scopus 和 CINAHL。研究的预设纳入标准考虑了诊断准确性、横断面、前瞻性观察性和回顾性研究，重点是颅内压升高的儿童，原因包括创伤性脑损伤和脑水肿，使用超声测量视神经鞘直径的诊断准确性。主要结局指标包括敏感性和特异性。该研究包括有创监测（外部脑室引流）和非侵入性措施作为颅内压升高的金标准。两名作者提取和审查了数据。提取基线数据、结局测量和诊断准确性数据。
共分析了 25 项研究，涉及 1591 例患者和 3143 次经超声测量的 ONSD。经超声测量的 ONSD 预测颅内压升高的敏感性和特异性分别为 92%（86%-96%）和 89%（77%-96%）。汇总的阳性和阴性似然比分别为 8.6 和 0.08。
视神经超声检查是一种精确且有价值的诊断工具，适用于不同的患者人群和临床情况。我们建议在儿科患者中常规进行眼部超声检查以测量视神经鞘直径，以提高颅内压升高的诊断准确性。
