Pediatrics World Conference 2026

Abstract

Background:

Raised intracranial pressure (ICP) is a life-threatening emergency requiring prompt recognition and intervention. Although invasive ICP monitoring remains the gold standard, its use is limited by procedural risks and the need for specialized expertise. Ultrasonographic measurement of the Optic Nerve Sheath Diameter (ONSD) has emerged as a rapid, bedside, non-invasive alternative for detecting raised ICP.

Objective: To evaluate the diagnostic accuracy of Transbulbar Ultrasonographic measurement of ONSD as a screening tool for raised intracranial pressure in children by comparing it with neuroimaging findings.

Methods:
A prospective observational study was conducted between October 2020 and September 2021 in the Pediatric Intensive Care Unit of a tertiary care teaching hospital in South India. Sixty children aged 2–12 years with clinical suspicion of raised ICP and age-matched controls were enrolled. ONSD was measured using a high-frequency linear ultrasound probe in both axial and coronal planes at 3 mm posterior to the globe. CT/MRI findings served as the reference standard, while fundus examination was performed for comparison. Statistical analysis included receiver operating characteristic (ROC) curve analysis to determine the optimal diagnostic cut-off.

Conclusion: Transbulbar Ultrasonographic measurement of ONSD is a simple, rapid, non-invasive bedside screening modality with high sensitivity for identifying raised intracranial pressure in children. It serves as a valuable adjunct to clinical assessment and neuroimaging, particularly in emergency and intensive care settings where early diagnosis is critical. Wider incorporation of ONSD into point-of-care ultrasound protocols may facilitate timely recognition and management of pediatric intracranial hypertension.