Optic nerve sheath diameter does not correlate with intracranial pressure in pediatric neurocritical care patients

Purpose Intracranial pressure (ICP) > 20 mmHg is associated with worse outcomes in children. The gold standard for monitoring ICP is invasive, has complications such as bleeding and infection, and may not be available in resource limited areas. Ultrasound of the optic nerve sheath diameter (ONSD) has been studied as a noninvasive way to evaluate for elevated ICP in adults. Its utility in pediatrics remains unclear. Methods A prospective study was performed in a pediatric intensive care unit in children ≤ 18 years old. ONSD ultrasound was performed using a 13–6 MHz linear probe with the patient’s invasively measured ICP simultaneously recorded. Linear mixed effects models were used to evaluate the association between ONSD and ICP. Results One hundred thirty-six measurements were obtained from 16 patients. ONSD was not significantly associated with ICP ( p = 0.51). A ROC curve assessing ONSD to determine elevated ICP > 20 mmHg had an area under the curve of 0.52 (95%CI = 0.32–0.72). There was no difference in measurements obtained between the left and right ONSD at the same time ( p = 0.82). Conclusions In conclusion, this study demonstrated no association between ONSD measurement and invasively monitored ICP in critically ill children.