title: The Use of Ultrasound-Measured Optic Nerve Sheath Diameter to Predict Ventriculoperitoneal Shunt Failure in Children.
abstract: OBJECTIVE
  The goal of this study was to assess the accuracy of ultrasound-measured optic nerve sheath diameter (ONSD) as a screen for ventriculoperitoneal shunt failure.
  
  
  METHODS
  We prospectively enrolled a convenience sample of children presenting to the ED with suspected shunt failure. The ONSD was measured by ultrasound and compared with computed tomography/magnetic resonance imaging (CT/MRI) and neurosurgical impression. We defined shunt failure on ultrasound as an ONSD greater than 4.0 mm in infants 12 months and younger or greater than 4.5 mm in children older than 12 months. A single emergency radiologist at our institution read all CTs and MRIs for categorical determination of shunt failure. We defined shunt failure based on neurosurgical impression as a decision to admit and perform shunt revision. We report test characteristics and 95% confidence intervals of ONSD as a predictor for shunt failure.
  
  
  RESULTS
  We enrolled 32 subjects. The sensitivities of ONSD compared with CT/MRI and neurosurgical impression, 60.0% and 75.0%, respectively, were low. However, the negative predictive values of ONSD compared with CT/MRI and neurosurgical impression were 90.0% and 95.0%, respectively.
  
  
  CONCLUSIONS
  Optic nerve sonography may be a useful tool to identify children presenting with suspected ventriculoperitoneal shunt failure who do not require further imaging. This would reduce the use of CT scan and exposure to ionizing radiation in children with suspected shunt malfunction who do not require neurosurgical intervention. Consideration of additional risk factors and a larger sample size may yield stronger results.
authors.forename: Sophia D
authors.initials: SD
authors.lastname: Lin
authors.affiliation: Departments of Pediatrics and.
authors.forename: Kimberly R
authors.initials: KR
authors.lastname: Kahne
authors.affiliation: Departments of Pediatrics and.
authors.forename: Amira
authors.initials: A
authors.lastname: El Sherif
authors.affiliation: Radiology, Weill Cornell Medical College, New York, NY.
authors.forename: Kevin
authors.initials: K
authors.lastname: Mennitt
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia College of Physicians and Surgeons, New York, NY.
authors.forename: David
authors.initials: D
authors.lastname: Kessler
authors.affiliation: Departments of Pediatrics and.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Ward
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, and.
authors.forename: Shari L
authors.initials: SL
authors.lastname: Platt
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D004868:Equipment Failure / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods; D008403:Mass Screening / Q000379:methods; D009900:Optic Nerve / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography / Q000379:methods*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*; D055815:Young Adult