Age-Specific Optic Nerve Sheath Diameter Cut-Off Values for Detecting Raised Intracranial Pressure in Children: A Systematic Review and Meta-Analysis

This study aims to systematically evaluate the diagnostic accuracy and age-specific cut-off values of optic nerve sheath diameter (ONSD) measured using ultrasonography for detecting raised intracranial pressure (ICP) in pediatric populations. Raised ICP is a critical condition in children with neurological disorders, including traumatic brain injury, hydrocephalus, infections, and intracranial tumors. Non-invasive bedside techniques such as ONSD ultrasonography have gained increasing attention as potential screening tools for early ICP detection. A systematic review and diagnostic meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Multiple electronic databases were searched to identify relevant studies evaluating ONSD as a diagnostic marker for raised ICP in children. Eligible studies included pediatric participants aged 0–18 years and reported diagnostic accuracy data comparing ONSD measurements with reference standards such as invasive intracranial pressure monitoring, computed tomography (CT), magnetic resonance imaging (MRI), or lumbar puncture. Data extracted from included studies comprised study characteristics, participant demographics, diagnostic thresholds, and diagnostic accuracy parameters including sensitivity, specificity, true positives, false positives, true negatives, and false negatives. A hierarchical summary receiver operating characteristic (HSROC) model and random-effects meta-analysis were used to estimate pooled diagnostic accuracy. The study also explores age-specific variations in ONSD cut-off values across pediatric age groups. The findings aim to support clinical decision-making and provide evidence for the use of ONSD ultrasonography as a non-invasive screening tool for raised intracranial pressure in children.