Truong DMT, Nguyen MHN, Nguyen HQ, Vo LT, Nguyen TT. Optic nerve sheath diameter trajectories and mortality in children with clinically relevant elevated intracranial pressure. World J Crit Care Med 2025; 14(4): 110669 [DOI: 10.5492/wjccm.v14.i4.110669]
Corresponding Author of This Article
Thanh Tat Nguyen, MD, PhD, Department of Tuberculosis and Epidemiology, Woolcock Institute of Medical Research, Pham Ngoc Thach, Ho Chi Minh City 700000, Viet Nam. thanhhonor@gmail.com
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Critical Care Medicine
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Observational Study
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Dec 9, 2025 (publication date) through Dec 9, 2025
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World Journal of Critical Care Medicine
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Truong DMT, Nguyen MHN, Nguyen HQ, Vo LT, Nguyen TT. Optic nerve sheath diameter trajectories and mortality in children with clinically relevant elevated intracranial pressure. World J Crit Care Med 2025; 14(4): 110669 [DOI: 10.5492/wjccm.v14.i4.110669]
World J Crit Care Med. Dec 9, 2025; 14(4): 110669 Published online Dec 9, 2025. doi: 10.5492/wjccm.v14.i4.110669
Optic nerve sheath diameter trajectories and mortality in children with clinically relevant elevated intracranial pressure
Dat Minh-Tan Truong, Minh Hoang-Nhat Nguyen, Huy Quang Nguyen, Luan Thanh Vo, Thanh Tat Nguyen
Dat Minh-Tan Truong, Department of Intensive Care Unit, Children’s Hospital 2, Ho Chi Minh City 700000, Viet Nam
Minh Hoang-Nhat Nguyen, Department of Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Viet Nam
Huy Quang Nguyen, Department of Radiology, Children’s Hospital 2, Ho Chi Minh City 700000, Viet Nam
Luan Thanh Vo, Thanh Tat Nguyen, Department of Infectious Diseases, Children's Hospital 2, Ho Chi Minh City 700000, Viet Nam
Thanh Tat Nguyen, Department of Tuberculosis and Epidemiology, Woolcock Institute of Medical Research, Ho Chi Minh City 700000, Viet Nam
Author contributions: Truong DMT, Vo LT, Nguyen TT contributed to conceptualization, critical revision of the final manuscript; Truong DMT, Nguyen MHN, Nguyen HQ contributed to data curation, investigation; Nguyen TT contributed to formal analysis; Truong DMT, Nguyen TT contributed to writing-original draft, methodology; all authors have contributed to and approved the final manuscript.
Institutional review board statement: This study was conducted at Children’s Hospital 2, a tertiary care pediatric hospital in southern Vietnam. Ethical approval was granted by the Scientific Committee and Institutional Review Board of Children’s Hospital 2, Ho Chi Minh City (IRB No. 370/GCN-BVND2).
Informed consent statement: Informed consent was obtained from all participants. All procedures were performed in strict accordance with the principles of Good Clinical Practice and ethical standards outlined in the Declaration of Helsinki.
Conflict-of-interest statement: All authors declare that there is no conflict of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Data sharing statement: The original contributions of this study are included in the article and supplementary material. Further requests can be directed to the corresponding authors.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thanh Tat Nguyen, MD, PhD, Department of Tuberculosis and Epidemiology, Woolcock Institute of Medical Research, Pham Ngoc Thach, Ho Chi Minh City 700000, Viet Nam. thanhhonor@gmail.com
Received: June 12, 2025 Revised: July 1, 2025 Accepted: September 24, 2025 Published online: December 9, 2025 Processing time: 170 Days and 2.6 Hours
Abstract
BACKGROUND
The optic nerve sheath diameter (ONSD) measured by ultrasound has emerged as a significant noninvasive method for detecting elevated intracranial pressure (ICP), guiding timely interventions, and monitoring treatment response. Previous studies have shown that the baseline ONSD at admission is a prognostic indicator of mortality in adult patients with cerebrovascular events, traumatic brain injury, hepatic encephalopathy, and acute stroke. However, pediatric data on the dynamic changes in ONSD remain limited.
AIM
To study the association between within-48 hours admission dynamic ONSD changes and mortality in children with clinically relevant elevated ICP.
METHODS
This single-institution prospective study was performed at a tertiary Children’s Hospital in Vietnam, between November 2023 and August 2024. The primary outcome was in-hospital mortality rate. ONSD data were measured at admission, 24 hours, and 48 hours post-admission to pediatric intensive care unit (PICU). Linear mixed-effects models accounting for repeated measures within individuals were used to analyze the association between ONSD changes and in-hospital mortality.
RESULTS
A total of 69 PICU-admitted children with clinically relevant raised ICP were enrolled and included in the analysis. The median patient age was 6 years (interquartile range: 1-12), and males accounted for 54% of all patients. The in-hospital mortality rate in children with clinically relevant raised ICP was 23.2%. Traumatic brain injury, sepsis-associated encephalopathy, and septic shock were the main causes of death in this cohort. Linear mixed-effects analysis showed that dynamic variability in ONSD values upon PICU admission and during the first 48 hours later correlated significantly with increased mortality. Nonsurvivors had a 5.3% increase in the mean ONSD at 48 hours compared to baseline levels, while the survivors showed a 5.6% reduction in ONSD.
CONCLUSION
Serial ultrasound-based ONSD measurements within 48 hours of admission better predicted mortality than baseline data in critically ill children, offering a practical, noninvasive tool for early prognosis in elevated ICP.
Core Tip: The in-hospital mortality rate in children hospitalized with clinically relevant raised intracranial pressure was 23.2%. Nonsurvivors had a median 5.3% increase in ultrasound-measured optic nerve sheath diameter (ONSD), whereas survivors showed median 5.6% reduction during the first 48 hours of admission. Early changes in ONSD, as measured by ultrasound during the first 48 hours of admission, were strongly correlated with neurological deterioration and mortality risk.
