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Predictive Value of Optic Nerve Sheath Diameter for Diagnosis of Intracranial Hypertension in Children With Severe Brain Injury

  • Cour-Andlauer, Fleur1, 2
  • Portefaix, Aurélie3, 4
  • Wroblewski, Isabelle5
  • Rabilloud, Muriel6, 7, 8, 9
  • Bordet, Fabienne1
  • Cogniat, Bérengère10
  • Didier, Capucine1
  • Pouyau, Robin1
  • Valla, Frédéric V.1
  • Kassai-Koupai, Behrouz3, 4
  • Siméon, Gaëlle11
  • Ginhoux, Tiphanie3, 4
  • Courtil-Teyssedre, Sonia1
  • Javouhey, Etienne1, 2
  • 1 Hospices Civils de Lyon, Paediatric Intensive Care Unit, Mother and Children University Hospital, Bron , (France)
  • 2 EA 7426 “Pathophysiology of Injury-Induced Immunosuppression” (Université Claude Bernard Lyon 1 – Hospices Civils de Lyon – bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon , (France)
  • 3 Clinical Investigation Center CIC 1407, Hospices Civils de Lyon, Bron , (France)
  • 4 CNRS, UMR 5558, Laboratory of Biometry and Evolutionary Biology, University of Lyon 1, Villeurbanne , (France)
  • 5 Pediatric Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble , (France)
  • 6 Université de Lyon, Lyon , (France)
  • 7 Université Lyon 1, Villeurbanne , (France)
  • 8 Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon , (France)
  • 9 CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne , (France)
  • 10 Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Mother and Children University Hospital, Bron , (France)
  • 11 Pharmacology and Therapeutics Laboratory, University of Lyon 1, Lyon , (France)
Published Article
Frontiers in Pediatrics
Frontiers Media SA
Publication Date
Jun 06, 2022
DOI: 10.3389/fped.2022.894449
  • Pediatrics
  • Original Research


Background and Aims Intracranial Hypertension (ICH) is a life-threatening complication of brain injury. The invasive measurement of intracranial pressure (ICP) remains the gold standard to diagnose ICH. Measurement of Optic Nerve Sheath Diameter (ONSD) using ultrasonography is a non-invasive method for detecting ICH. However, data on paediatric brain injury are scarce. The aim of the study was to determine the performance of the initial ONSD measurement to predict ICH occurring in children with severe brain injury and to describe the ONSD values in a control group. Methods In this cross-sectional study, ONSD was measured in children aged 2 months-17 years old with invasive ICP monitoring: before placement of ICP probe and within the 60 min after, and then daily during 3 days. ONSD was also measured in a control group. Results Ninety-nine patients were included, of whom 97 were analysed, with a median (IQR) age of 8.7 [2.3–13.6] years. The median (IQR) PIM 2 score was 6.6 [4.4–9.7] and the median (IQR) PELOD score was 21 [12–22]. Aetiologies of brain injury were trauma (n = 72), infection (n = 17) and stroke (n = 8). ICH occurred in 65 children. The median (IQR) ONSD was 5.58 mm [5.05–5.85]. ONSD performed poorly when it came to predicting ICH occurrence within the first 24 h (area under the curve, 0.58). There was no significant difference between the ONSD of children who presented with ICH within the first 24 h and the other children, with a median (IQR) of 5.6 mm [5.1–5.9] and 5.4 mm [4.9–5.8], respectively. Infants aged less than 2 years had a median (IQR) ONSD of 4.9 mm [4.5–5.2], significantly different from children aged more than 2 years, whose median ONSD was 5.6 mm [5.2–5.9]. Age, aetiology or ICP levels did not change the results. Thirty-one controls were included, with a median age of 3.7 (1.2–8.8) years. The median (IQR) of their ONSD measurement was 4.5 mm [4.1–4.8], significantly lower than the patient group. Conclusion In a paediatric severe brain injury population, ONSD measurement could not predict the 24 h occurrence of ICH. Severity of patients, timing and conditions of measurements may possibly explain these results.

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