title: Optic nerve sheath measurement and raised intracranial pressure in paediatric traumatic brain injury.
abstract: BACKGROUND
  The optimal management of children ventilated for more than 4 h with traumatic brain injury (TBI) necessitates invasive intracranial pressure (ICP) monitoring, though some patients never have raised ICP. If non-invasive screening can reliably rule out elevated ICP, invasive devices can be limited to those in whom neuro-intensive care measures are indicated.
  
  
  METHODS
  We measured the optic nerve sheath diameter (ONSD) with a 10-MHz ultrasound probe in 11 children (age range 2-15 years, median 9.2 years) with severe TBI admitted to a regional neuro-surgical paediatric intensive care unit (PICU) requiring ICP monitoring and neuro-protection. Simultaneous invasive ICP was recorded and more than 15 mmHg was considered to be abnormal. ONSD >4.5 mm in children over 1 year of age was considered to be abnormal.
  
  
  CONCLUSIONS
  All children with clinically significantly raised ICP had abnormal ONSD, whereas those with normal ICP did not. Despite the small numbers, this study suggests that the ONSD may be useful in identifying children with TBI and normal ICP and, so, help avoid the insertion of unnecessary ICP monitors.
authors.affiliation: Paediatric and Neonatal Intensive Care Unit, Institute of Child Health and Great Ormond Street Hospital for Children, London, WC1N 3JH, UK. shragrawal@gmail.com.|PICU, St. Mary's Hospital, London, W2 1NY, UK. shragrawal@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Paediatric and Neonatal Intensive Care Unit, Institute of Child Health and Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
authors.forename: J
authors.initials: J
authors.lastname: Brierley
keywords: Intracranial pressure; Optic nerve sheath; Paediatric; Traumatic brain injury
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