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Transorbital point-of-care ultrasound versus fundoscopic papilledema to support treatment indication for potentially elevated intracranial pressure in children

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Název: Transorbital point-of-care ultrasound versus fundoscopic papilledema to support treatment indication for potentially elevated intracranial pressure in children
Autoři: Kerscher, Susanne Regina, Zipfel, Julian, Haas-Lude, Karin, Bevot, Andrea, Tellermann, Jonas, Schuhmann, Martin Ulrich
Zdroj: Childs Nerv Syst
Informace o vydavateli: Springer Science and Business Media LLC, 2023.
Rok vydání: 2023
Témata: Intracranial Pressure, Point-of-Care Systems, US-based optic disc, Point-of-Care Systems [MeSH], Ultrasonography/methods [MeSH], Humans [MeSH], Prospective Studies [MeSH], Optic nerve sheath diameter, Fundoscopy, Intracranial Pressure/physiology [MeSH], Papilledema/diagnostic imaging [MeSH], Papilledema/complications [MeSH], Original Article, Elevated ICP, Reproducibility of Results [MeSH], Intracranial Hypertension/complications [MeSH], Optic Nerve/pathology [MeSH], Intracranial Hypertension/diagnostic imaging [MeSH], Child [MeSH], Optic Nerve/diagnostic imaging [MeSH], Reproducibility of Results, Optic Nerve, 3. Good health, Humans, Prospective Studies, Intracranial Hypertension, Child, Papilledema, Ultrasonography
Popis: Purpose To compare transorbital point-of-care ultrasound techniques —optic nerve sheath diameter (US-ONSD) and optic disc elevation (US-ODE)— with fundoscopic papilledema to detect potentially raised intracranial pressure (ICP) with treatment indication in children. Methods In a prospective study, 72 symptomatic children were included, 50 with later proven disease associated with raised ICP (e.g. pseudotumour cerebri, brain tumour, hydrocephalus) and 22 with pathology excluded. Bilateral US-ONSD and US-ODE were quantified by US using a 12-MHz-linear-array transducer. This was compared to fundoscopic optic disc findings (existence of papilledema) and, in 28 cases, invasively measured ICP values. Results The sensitivity and specificity of a cut-off value of US-ONSD (5.73 mm) to detect treatment indication for diseases associated with increased ICP was 92% and 86.4%, respectively, compared to US-ODE (0.43 mm) with sensitivity: 72%, specificity: 77.3%. Fundoscopic papilledema had a sensitivity of 46% and a specificity of 100% in this context. Repeatability and observer-reliability of US-ODE examination was eminent (Cronbach’s α = 0.978–0.989). Papilledema was detected fundoscopically only when US-ODE was > 0.67 mm; a US-ODE > 0.43 mm had a positive predictive value of 90% for potentially increased ICP. Conclusion In our cohort, transorbital point-of-care US-ONSD and US-ODE detected potentially elevated ICP requiring treatment in children more reliably than fundoscopy. US-ONSD and US-ODE indicated the decrease in ICP after treatment earlier and more reliably than fundoscopy. The established cut-off values for US-ONSD and US-ODE and a newly developed US-based grading of ODE can be used as an ideal first-line screening tool to detect or exclude conditions with potentially elevated ICP in children.
Druh dokumentu: Article
Other literature type
Popis souboru: application/pdf
Jazyk: English
ISSN: 1433-0350
0256-7040
DOI: 10.1007/s00381-023-06186-7
DOI: 10.18725/oparu-55317
Přístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/37962632
http://nbn-resolving.de/urn:nbn:de:bsz:289-oparu-55392-6
https://doi.org/10.18725/OPARU-55317
https://repository.publisso.de/resource/frl:6516625
Rights: CC BY
Přístupové číslo: edsair.doi.dedup.....8346328e8ec3f8dbb4db8a20c0e0c0d9
Databáze: OpenAIRE
Popis
Abstrakt:Purpose To compare transorbital point-of-care ultrasound techniques —optic nerve sheath diameter (US-ONSD) and optic disc elevation (US-ODE)— with fundoscopic papilledema to detect potentially raised intracranial pressure (ICP) with treatment indication in children. Methods In a prospective study, 72 symptomatic children were included, 50 with later proven disease associated with raised ICP (e.g. pseudotumour cerebri, brain tumour, hydrocephalus) and 22 with pathology excluded. Bilateral US-ONSD and US-ODE were quantified by US using a 12-MHz-linear-array transducer. This was compared to fundoscopic optic disc findings (existence of papilledema) and, in 28 cases, invasively measured ICP values. Results The sensitivity and specificity of a cut-off value of US-ONSD (5.73 mm) to detect treatment indication for diseases associated with increased ICP was 92% and 86.4%, respectively, compared to US-ODE (0.43 mm) with sensitivity: 72%, specificity: 77.3%. Fundoscopic papilledema had a sensitivity of 46% and a specificity of 100% in this context. Repeatability and observer-reliability of US-ODE examination was eminent (Cronbach’s α = 0.978–0.989). Papilledema was detected fundoscopically only when US-ODE was > 0.67 mm; a US-ODE > 0.43 mm had a positive predictive value of 90% for potentially increased ICP. Conclusion In our cohort, transorbital point-of-care US-ONSD and US-ODE detected potentially elevated ICP requiring treatment in children more reliably than fundoscopy. US-ONSD and US-ODE indicated the decrease in ICP after treatment earlier and more reliably than fundoscopy. The established cut-off values for US-ONSD and US-ODE and a newly developed US-based grading of ODE can be used as an ideal first-line screening tool to detect or exclude conditions with potentially elevated ICP in children.
ISSN:14330350
02567040
DOI:10.1007/s00381-023-06186-7