What Optic Disk Elevation on Pediatric Ocular Point-Of-Care Ultrasound Predicts Increased Intracranial Pressure? A Retrospective Analysis
2Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, קנדה
Background: Papilledema is an important finding in cases of increased intracranial pressure (IICP), but is often difficult to detect in children. Optic disk elevation (ODE), a component of papilledema, measured by ocular point-of-care ultrasound (O-POCUS), is associated with IICP but no pediatric cutoff values have been established
Objective: To establish the diagnostic accuracy of ODE cutoffs to detect IICP in children who underwent O-POCUS in our pediatric emergency department (PED).
Methods: Retrospectively charts review of patients who presented over a 5 year period to our PED and received O-POCUS. Patients were included if their underwent invasive IICP measurement within 14 days after O-POCUS. An O-POCUS US expert blinded to the clinical course measured ODE. Receiver-operator curve analysis was performed for various cutoffs for these measurements in detecting IICP.
Results: 40 patients met study criteria. A cut-off of 0.33 mm for the mean ODEB produced a sensitivity of 100% (95% C.I. 87.2-100%) but a specificity of only 50% (95% C.I. 53.9-80.8%), while a cut-off of 0.84 mm produced a sensitivity of only 48.2% (95% C.I. 28.7-68.1%) but a specificity of 100% (95% CI 75.3-100%). A cut-off of 0.74 mm for ODEB produced the best combination of sensitivity (88.9%, 95% C.I. 76-100%) and specificity (93%, 95% CI 83%-100%).
Conclusion: Children with an ODEB < 0.33 mm on O-POCUS were highly unlikely to have IICP, while those with an ODEB > 0.84 mm were highly likely to have IICP. O-POCUS may be a useful new tool for physicians managing children with possible IICP.
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