• Gunaseelan Rajendran, Sasikumar Mahalingam, Anitha Ramkumar, Sathish Rajaa, Kumaresh P T, Aswin K, Rajkumar Elanjaeran, Rahini Kannan, Sathya Prakasam, Anas Salih, and Vivek Nayagam.
• Department of Emergency Medicine and Trauma, Aarupadai Veedu Medical College and Hospital, Vinayaka Missions' Research Foundation (DU), Puducherry, India. Electronic address: drrigs08tkmc@gmail.com.
• World Neurosurg. 2024 Oct 1; 190: e1000e1017e1000-e1017.

PurposeDetecting increased intracranial pressure early in pediatric patients is essential, as early initiation of therapy prevents morbidity and mortality. The objective of this study was to determine the diagnostic accuracy of the optic nerve sheath diameter (ONSD) measured via ultrasound for the prediction of increased intracranial pressure.MethodsFour databases, namely, PubMed, EMBASE, Scopus, and CINAHL, were searched for this systematic review and meta-analysis. The study's predefined inclusion criteria considered diagnostic accuracy, cross-sectional, prospective observational, and retrospective studies with a focus on children with elevated intracranial pressure from causes such as traumatic brain injury and cerebral edema, the diagnostic accuracy of the optic nerve sheath diameter measured using ultrasound was assessed. The primary outcome measures included sensitivity and specificity. The study included invasive monitoring (external ventricular drain) and noninvasive measures as the gold standards for increased intracranial pressure. Two authors extracted and reviewed the data. Baseline data, outcome measures, and diagnostic accuracy data were extracted.ResultsTwenty-five studies with 1591 patients and 3143 ONSD measurements via ultrasound were analyzed. The pooled sensitivity and specificity of the ONSD measured via ultrasound for the prediction of increased intracranial pressure were 92% (86%-96%) and 89% (77%-96%), respectively. The pooled positive and negative likelihood ratios were 8.6 and 0.08, respectively.Conclusion And RelevanceOptic nerve ultrasonography stands out as a precise and valuable diagnostic tool applicable across diverse patient populations and clinical scenarios. We recommend routine ocular ultrasound for optic nerve sheath diameter measurement in pediatric patients to increase the accuracy of diagnosing increased intracranial pressure.Copyright © 2024 Elsevier Inc. All rights reserved.

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