Pediatric point-of-care ultrasound of optic disc elevation for increased intracranial pressure: A pilot study

Objective: Papilledema is often difficult to detect in children. Ocular point-of-care ultrasound (POCUS) measurement of the optic nerve sheath diameter (ONSD) is a non-invasive test for increased intracranial pressure (ICP), but no consensus exists on normal pediatric ONSD values. Detection of optic disc elevation (ODE, a component of papilledema) using POCUS has recently been qualitatively described. We sought to establish the diagnostic accuracy of different ODE cutoffs to detect increased ICP in children who underwent ocular POCUS in our pediatric emergency department (PED). Methods: We retrospectively reviewed charts of patients ages 0–18 years who received ocular POCUS in our tertiary PED between 2011 and 2016. Patients were included if their archived POCUS examinations were deemed high-quality by a POCUS expert and they underwent ICP determination within 48 h after ocular POCUS. A blinded POCUS expert measured ODE, optic disc width at mid-height (ODWAMH), and ONSD. Receiver-operator curve analysis was performed for various cutoffs for these measurements in detecting increased ICP. Results: 76 eyes from 40 patients met study criteria. 26 patients had increased ICP. The mean ODE of both eyes (ODE-B) generated the largest area under the curve (0.962, 95% CI 0.890–1). The optimal ODE-B cutoff was 0.66 mm, with a sensitivity of 96% (95% CI 79–100%) and a specificity of 93% (95% CI 79–100%). 1/40 (2.5%) of patients with ODE-B < 0.66 had increased ICP. Conclusions: ODE-B may represent the optimal ocular POCUS measurement for detecting increased ICP in children, and future prospective studies could more accurately describe the diagnostic performance of different pediatric ODE-B cutoffs.