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Papilloedema: a highly specific predictor of raised intracranial pressure in a complex neurosurgical paediatric cohort

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Abstract

Purpose

Papilloedema is recognised as an indicator of raised intracranial pressure, although there is a paucity of literature describing the utility of fundoscopy in screening for raised ICP in children with craniofacial synostosis, particularly young children. We sought to investigate the association of optic disc morphology with ICP in children, and to define the sensitivity and specificity of papilloedema as a clinical indicator of raised ICP and determine if age, or underlying conditions impact the findings.

Method

Retrospective analysis of all patients undergoing ICP monitoring at a designated paediatric neurosurgical and craniofacial unit in the United Kingdom between October 2009 and October 2018. The fundoscopy findings and ICP monitoring data were analysed for 31 children with craniosynostosis and 29 children without craniosynostosis.

Results

All children who had papilloedema had raised ICP confirmed with monitoring. Across the 60-patient cohort, confirmed papilloedema on fundoscopy had Positive Predictive Value (PPV) of 1.00, Negative Predictive Value (NPV) of 0.64 with sensitivity 48% and specificity 100% for the presence of raised ICP (p =  < 0.0001). In the craniosynostosis group, PPV was 1.00, NPV was 0.39, sensitivity 48% and specificity 100% (p =  < 0.03). There is no correlation between severity of optic disc swelling using Frisen grading and elevation of ICP. Age did not affect the presence of papilloedema in those with raised ICP.

Conclusion

The presence of papilloedema is a strong indicator of raised ICP in a child, regardless of underlying aetiology. Detailed fundoscopy can prevent the need for further investigations including imaging-related radiation and invasive CSF pressure monitoring.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Craniofacial Surgery, Birmingham Women and Children’s Foundation NHS Trust, Birmingham, United Kingdom

    Alexander Mitchell, Azam Ali Baig, Usama Kanj, Desiderio Rodrigues, Sally Painter & Joseph Abbott

Authors
  1. Alexander Mitchell
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  2. Azam Ali Baig
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  3. Usama Kanj
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  4. Desiderio Rodrigues
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  5. Sally Painter
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  6. Joseph Abbott
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Contributions

Alexander Mitchell, Azam Ali Baig, Usama Kanj, Desiderio Rodrigues, Sally Painter and Joseph Abbott contributed to the study conception and design. Material preparation, data collection and analysis were performed by Alexander Mitchell, Azam Baig and Usama Kanj. The first draft of the manuscript was written by Alexander Mitchell and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alexander Mitchell.

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Ethical approval

This retrospective analysis of clinical notes was approved by Birmingham Children’s Hospital governance committee. The study abided by the Declaration of Helsinki.

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The authors have no financial or non-financial competing interests to declare that are relevant to the content of this article.

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Mitchell, A., Baig, A.A., Kanj, U. et al. Papilloedema: a highly specific predictor of raised intracranial pressure in a complex neurosurgical paediatric cohort. Childs Nerv Syst 40, 463–469 (2024). https://doi.org/10.1007/s00381-023-06137-2

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  • DOI: https://doi.org/10.1007/s00381-023-06137-2

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