Optic nerve sheath diameter/eyeball transverse diameter ratio by ultrasound in prediction of increased intracranial pressure in children with viral encephalitis.
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Abstract
Introduction: Increased intracranial pressure (ICP) is common with viral encephalitis in children which is associated with complications and prognosis. The optic nerve sheath diameter (ONSD) is a new indicator for the assessment of intracranial pressure using ultrasound, CT scan and MRI imaging. Given the influence of physical development on ONSD size in children, we expect more accurate assessment of intracranial pressure with ONSD/ETD (eyeball transverse diameter) ratio by ultrasound. The aim of the study is to determine the performance of the ONSD/ETD ratio measurement to predict ICP occurring in children with viral encephalitis and evaluate the therapeutic effect.
Methods: Children with viral encephalitis from May 2022 to June 2024 were recruited in this study. The initial ONSD/ETD ratio measurement by ultrasound were completed before lumbar puncture. Children were divided into the increased ICP group and the normal ICP group based on whether the ICP was over 200 mmH2O measured by lumbar puncture. The ultrasound was repeated on the 3rd and 7th day of treatment.
Results: The ONSD/ETD ratios measured in the two groups before treatment were 0.231 ± 0.019 and 0.182 ± 0.012, respectively (p < 0.01). The ONSD/ETD ratio on the 3rd day of treatment in the increased ICP group was significantly lower than the data before treatment (p < 0.01). The data on the 7th day of treatment in increased ICP group was significantly lower than the data before treatment (p < 0.01), but not statistically significant compared to the data on the 3rd day of treatment (p = 0.650). The ROC curve demonstrated an AUC for ONSD/ETD ratio in predicting the occurrence of increased ICP in children with viral encephalitis was 0.974 [95% confidence interval (CI): 0.939-1.000, p < 0.01], with a sensitivity of 95.1% and specificity of 93.3% at a cut-off value of 0.198.
Conclusion: Our study shows that ONSD/ETD can be used as an easy reference tool for evaluating ICP in children with viral encephalitis which can reflect the therapeutic effect.
颅内压增高是儿童病毒性脑炎的常见病，与并发症和预后有关。视神经鞘直径（ONSD）是超声、CT和MRI评价颅内压的新指标。考虑到身体发育对儿童ONSD大小的影响，我们希望超声ONSD/ETD（眼球横径）比值能更准确地评估颅内压。本研究的目的是确定ONSD/ETD比值测量的性能，以预测病毒性脑炎患儿发生ICP，并评估其治疗效果。方法：选取2022年5月至2024年6月期间患有病毒性脑炎的儿童为研究对象。超声测量初始ONSD/ETD比值在腰椎穿刺前完成。根据腰椎穿刺测量颅内压是否大于200mmh2o分为颅内压增高组和正常颅内压组。在治疗第3、7天重复超声检查。结果：两组治疗前的ONSD/ETD比值分别为0.231±0.019和0.182±0.012 （p p p = 0.650）。ROC曲线显示，ONSD/ETD比值预测病毒性脑炎患儿颅内压增高的AUC为0.974[95%可信区间（CI）： 0.939 ~ 1.000, p]。结论：本研究表明，ONSD/ETD可作为评估病毒性脑炎患儿颅内压的简便参考工具，能反映治疗效果。
期刊介绍：
Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.
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