The diagnostic utility of point-of-care ultrasound (POCUS) and optical coherence tomography (OCT) for papilledema in children: A prospective pilot study 

Authors: Hannah H. Chiu, Michael J. Wan, Agnes Wong, Mark Tessaro.

Author Disclosure Block:H.H. Chiu: Membership on advisory boards or speakers’ bureaus; Novartis, Bayer, Alcon. Membership on advisory boards. M.J. Wan: None. A. Wong: None. M. Tessaro: None.

Abstract Body:

Purpose: To study the diagnostic accuracy of point-of-care ultrasound (POCUS) and optical coherence tomography (OCT) for papilledema in children, using a clinical diagnosis of papilledema and elevated opening pressure on lumbar puncture as the gold standard.
Study Design: Prospective observational study
Methods: Children with suspected elevated intracranial pressure were recruited to the study. Patients were eligible if they underwent a lumbar puncture with opening pressure and had high-quality POCUS and OCT imaging. The POCUS was performed by a pediatric emergency physician and the OCT was performed by an experienced pediatric ophthalmic photographer, both blinded to the clinical findings. The POCUS and OCT parameters were analyzed to determine diagnostic accuracy.
Results: A total of 24 patients were included in the study, 16 (67%) with papilledema and 8 (33%) without. There were significant differences between the groups in the optic nerve head height (p=0.008) and optic nerve sheath diameter (p=0.016) on POCUS, and in the average retinal nerve fiber layer thickness on OCT (p<0.001). Average retinal nerve fiber layer thickness had the highest diagnostic accuracy with an area under the curve of 1.00 and a 100% sensitivity and 100% specificity for papilledema (threshold value of 110 µm). Optic nerve head height had an area under the curve of 0.84 and a 94% sensitivity and 50% specificity (threshold value of 5.0 mm). Optic nerve sheath diameter had an area under the curve of 0.80 and a 94% sensitivity and 50% specificity (threshold value of 0.9 mm).
Conclusions: Both OCT and POCUS can help to clinicians to diagnose papilledema in children. In this cohort, the average nerve fiber layer thickness on OCT had the highest diagnostic accuracy. Larger, high-quality studies are needed to further define the role of POCUS and OCT in assessing papilledema in children.