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Reliability and feasibility of optic nerve point-of-care ultrasound in pediatric patients with ventricular shunts

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Abstract

Purpose

To determine the interrater reliability of optic nerve sheath diameter (ONSD) and optic disc elevation (ODE) via ocular ultrasound by emergency and neurosurgery providers in children with ventricular shunts, and to explore the feasibility of acquiring and measuring images.

Methods

Two novices who underwent focused training and one expert in ocular ultrasound independently acquired images and measured ONSD and ODE on the same children, 0–18 years with ventricular shunts, blinded to each other’s images and measurements. Patient tolerance, image quality, and time-to-complete exams were recorded. Images meeting a priori defined quality metrics were included. Mixed models and bootstrap analysis were used to obtain inter-rater reliability and 95% confidence intervals.

Results

Eighty-one children were enrolled from August 2016 to July 2017, with mean age 9.6 years (SD 5.25, range 5 months–17.7 years). High-quality images (≥ 4 on 7-point quality Likert scale) were obtained in 83% of ONSD assessments and 95% of ODE assessments. The ICCONSD was 0.82 (95% CI 0.76–0.91) for right eyes and 0.73 (95% CI 0.69–0.85) for left, while ICCODE was 0.81 (95% CI 0.75–0.89) for right eyes and 0.85 (95% CI 0.79–0.91) for left. Mean study duration (both eyes) was 2:52 min (SD 54 s).

Conclusion

Clinicians generated high-quality ocular ultrasound images with excellent interrater reliability when acquiring and measuring images of ONSD and ODE in children with ventricular shunts.

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References

  1. Robba C, Santori G, Czosnyka M, Corradi F, Bragazzi N, Padayachy L et al (2018) Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med 44:1284–1294

    Article  Google Scholar 

  2. Lochner P, Fassbender K, Lesmeister M, Nardone R, Orioli A, Brigo F et al (2018) Ocular ultrasound for monitoring pseudotumor cerebri syndrome. J Neurol 265:356–361

    Article  Google Scholar 

  3. Tessaro MO, Friedman N, Al-Sani F, Gauthey M, Maguire B, Davis A (2021) Pediatric point-of-care ultrasound of optic disc elevation for increased intracranial pressure: a pilot study. Am J Emerg Med 49:18–23

    Article  Google Scholar 

  4. Bhargava V, Tawfik D, Tan YJ, Dunbar T, Haileselassie B, Su E (2020) Ultrasonographic optic nerve sheath diameter measurement to detect intracranial hypertension in children with neurological injury: a systematic review. Pediatr Crit Care Med 21:e858–e868

    Article  Google Scholar 

  5. Pershad J, Taylor A, Hall MK, Klimo P (2017) Imaging Strategies for Suspected Acute Cranial Shunt Failure: A Cost-Effectiveness Analysis. Pediatrics 140

  6. Hall MK, Spiro DM, Sabbaj A, Moore CL, Hopkins KL, Meckler GD (2013) Bedside optic nerve sheath diameter ultrasound for the evaluation of suspected pediatric ventriculoperitoneal shunt failure in the emergency department. Childs Nerv Syst 29:2275–2280

    Article  Google Scholar 

  7. Choi SH, Min KT, Park EK, Kim MS, Jung JH, Kim H (2015) Ultrasonography of the optic nerve sheath to assess intracranial pressure changes after ventriculo-peritoneal shunt surgery in children with hydrocephalus: a prospective observational study. Anaesthesia 70:1268–1273

    Article  Google Scholar 

  8. Lin SD, Kahne KR, El Sherif A, Mennitt K, Kessler D, Ward MJ et al (2019) The use of ultrasound-measured optic nerve sheath diameter to predict ventriculoperitoneal shunt failure in children. Pediatr Emerg Care 35:268–272

    PubMed  Google Scholar 

  9. Bäuerle J, Lochner P, Kaps M, Nedelmann M (2012) Intra- and interobsever reliability of sonographic assessment of the optic nerve sheath diameter in healthy adults. J Neuroimaging 22:42–45

    Article  Google Scholar 

  10. Moretti R, Pizzi B, Cassini F, Vivaldi N (2009) Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care 11:406–410

    Article  Google Scholar 

  11. Ballantyne SA, O'neill G, Hamilton R, Hollman AS (2002) Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound 15:145–149

  12. Bäuerle J, Schuchardt F, Schroeder L, Egger K, Weigel M, Harloff A (2013) Reproducibility and accuracy of optic nerve sheath diameter assessment using ultrasound compared to magnetic resonance imaging. BMC Neurol 13:187

    Article  Google Scholar 

  13. Abo AM, Alade KH, Rempell RG, Kessler D, Fischer JW, Lewiss RE et al (2019) Credentialing pediatric emergency medicine faculty in point-of-care ultrasound: expert guidelines. Pediatr Emerg Care. https://doi.org/10.1097/pec.0000000000001677

    Article  Google Scholar 

  14. Helmke K, Hansen HC (1996) Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension II. Patient study. Pediatr Radiol 26:706–710

  15. Roth KR, Gafni-Pappas G (2011) Unique method of ocular ultrasound using transparent dressings. J Emerg Med 40:658–660

    Article  Google Scholar 

  16. Bäuerle J, Nedelmann M (2011) Sonographic assessment of the optic nerve sheath in idiopathic intracranial hypertension. J Neurol 258:2014–2019

    Article  Google Scholar 

  17. Hansen HC, Helmke K, Kunze K (1994) Optic nerve sheath enlargement in acute intracranial hypertension. Neuro-Ophthalmology 14:345–354

    Article  Google Scholar 

  18. Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M (2007) Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 49:508–514

    Article  Google Scholar 

  19. Teismann N, Lenaghan P, Nolan R, Stein J, Green A (2013) Point-of-care ocular ultrasound to detect optic disc swelling. Acad Emerg Med 20:920–925

    Article  Google Scholar 

  20. Le A, Hoehn ME, Smith ME, Spentzas T, Schlappy D, Pershad J (2009) Bedside sonographic measurement of optic nerve sheath diameter as a predictor of increased intracranial pressure in children. Ann Emerg Med 53:785–791

    Article  Google Scholar 

  21. Oberfoell S, Murphy D, French A, Trent S, Richards D (2017) Inter-rater reliability of sonographic optic nerve sheath diameter measurements by emergency medicine physicians. J Ultrasound Med 36:1579–1584

    Article  Google Scholar 

  22. Browd SR, Ragel BT, Gottfried ON, Kestle JR (2006) Failure of cerebrospinal fluid shunts: part I: Obstruction and mechanical failure. Pediatr Neurol 34:83–92

    Article  Google Scholar 

  23. Bondurant CP, Jimenez DF (1995) Epidemiology of cerebrospinal fluid shunting. Pediatr Neurosurg 23:254–258; discussion 259

  24. Kim TY, Stewart G, Voth M, Moynihan JA, Brown L (2006) Signs and symptoms of cerebrospinal fluid shunt malfunction in the pediatric emergency department. Pediatr Emerg Care 22:28–34

    Article  Google Scholar 

  25. Stein SC, Guo W (2008) Have we made progress in preventing shunt failure? A critical analysis J Neurosurg Pediatr 1:40–47

    Article  Google Scholar 

  26. Cohen JS, Jamal N, Dawes C, Chamberlain JM, Atabaki SM (2014) Cranial computed tomography utilization for suspected ventriculoperitoneal shunt malfunction in a pediatric emergency department. J Emerg Med 46:449–455

    Article  Google Scholar 

  27. Mater A, Shroff M, Al-Farsi S, Drake J, Goldman RD (2008) Test characteristics of neuroimaging in the emergency department evaluation of children for cerebrospinal fluid shunt malfunction. CJEM 10:131–135

    Article  Google Scholar 

  28. Iskandar BJ, Sansone JM, Medow J, Rowley HA (2004) The use of quick-brain magnetic resonance imaging in the evaluation of shunt-treated hydrocephalus. J Neurosurg 101:147–151

    PubMed  Google Scholar 

  29. Soldatos T, Chatzimichail K, Papathanasiou M, Gouliamos A (2009) Optic nerve sonography: a new window for the non-invasive evaluation of intracranial pressure in brain injury. Emerg Med J 26:630–634

    Article  CAS  Google Scholar 

  30. Shuper A, Snir M, Barash D, Yassur Y, Mimouni M (1997) Ultrasonography of the optic nerves: clinical application in children with pseudotumor cerebri. J Pediatr 131:734–740

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. La Tour Medical Group, Geneva, Switzerland and University Hospitals of Geneva, Geneva, Switzerland

    Magali Gauthey

  2. Pediatric Emergency Medicine, Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON, M5G 1X8, Canada

    Mark O. Tessaro & Adrienne L. Davis

  3. Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Sara Breitbart & Abhaya V. Kulkarni

Authors
  1. Magali Gauthey
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  2. Mark O. Tessaro
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  3. Sara Breitbart
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  4. Abhaya V. Kulkarni
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  5. Adrienne L. Davis
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Correspondence to Adrienne L. Davis.

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Gauthey, M., Tessaro, M.O., Breitbart, S. et al. Reliability and feasibility of optic nerve point-of-care ultrasound in pediatric patients with ventricular shunts. Childs Nerv Syst 38, 1289–1295 (2022). https://doi.org/10.1007/s00381-022-05510-x

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  • DOI: https://doi.org/10.1007/s00381-022-05510-x

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