{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T07:50:10Z","timestamp":1779004210902,"version":"3.51.4"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>The goal of this study was to assess the accuracy of ultrasound-measured optic nerve sheath diameter (ONSD) as a screen for ventriculoperitoneal shunt failure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We prospectively enrolled a convenience sample of children presenting to the ED with suspected shunt failure. The ONSD was measured by ultrasound and compared with computed tomography\/magnetic resonance imaging (CT\/MRI) and neurosurgical impression. We defined shunt failure on ultrasound as an ONSD greater than 4.0 mm in infants 12 months and younger or greater than 4.5 mm in children older than 12 months. A single emergency radiologist at our institution read all CTs and MRIs for categorical determination of shunt failure. We defined shunt failure based on neurosurgical impression as a decision to admit and perform shunt revision. We report test characteristics and 95% confidence intervals of ONSD as a predictor for shunt failure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>We enrolled 32 subjects. The sensitivities of ONSD compared with CT\/MRI and neurosurgical impression, 60.0% and 75.0%, respectively, were low. However, the negative predictive values of ONSD compared with CT\/MRI and neurosurgical impression were 90.0% and 95.0%, respectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Optic nerve sonography may be a useful tool to identify children presenting with suspected ventriculoperitoneal shunt failure who do not require further imaging. This would reduce the use of CT scan and exposure to ionizing radiation in children with suspected shunt malfunction who do not require neurosurgical intervention. Consideration of additional risk factors and a larger sample size may yield stronger results.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000001034","type":"journal-article","created":{"date-parts":[[2017,1,10]],"date-time":"2017-01-10T18:01:22Z","timestamp":1484071282000},"page":"268-272","source":"Crossref","is-referenced-by-count":21,"title":["The Use of Ultrasound-Measured Optic Nerve Sheath Diameter to Predict Ventriculoperitoneal Shunt Failure in Children"],"prefix":"10.1097","volume":"35","author":[{"given":"Sophia D.","family":"Lin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly R.","family":"Kahne","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amira","family":"El Sherif","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Mennitt","sequence":"additional","affiliation":[{"name":"Radiology, Weill Cornell Medical College, New York, NY; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Kessler","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia College of Physicians and Surgeons, New York, NY."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary J.","family":"Ward","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shari L.","family":"Platt","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"bib1-20230930","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/01.pec.0000195764.50565.8c","article-title":"Signs and symptoms of cerebrospinal fluid shunt malfunction in the pediatric emergency department","volume":"22","year":"2006","journal-title":"Pediatr Emerg Care"},{"key":"bib2-20230930","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1001\/jamapediatrics.2013.311","article-title":"The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk","volume":"167","year":"2013","journal-title":"JAMA Pediatr"},{"key":"bib3-20230930","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.annemergmed.2008.11.025","article-title":"Bedside sonographic measurement of optic nerve sheath diameter as a predictor of increased intracranial pressure in children","volume":"53","year":"2009","journal-title":"Ann Emerg Med"},{"key":"bib4-20230930","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1007\/s00381-013-2172-y","article-title":"Bedside optic nerve sheath diameter ultrasound for the evaluation of suspected pediatric ventriculoperitoneal shunt failure in the emergency department","volume":"29","year":"2013","journal-title":"Childs Nerv Syst"},{"key":"bib5-20230930","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1136\/bjo.86.10.1109","article-title":"Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus","volume":"86","year":"2002","journal-title":"Br J Ophthalmol"},{"key":"bib6-20230930","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1016\/S0009-9260(99)91176-5","article-title":"Transorbital optic nerve sheath ultrasonography in normal children","volume":"54","year":"1999","journal-title":"Clin Radiol"},{"key":"bib7-20230930","first-page":"229","article-title":"Sonography of the optical nerve\u2014experience in 483 children [article in German]","volume":"177","year":"2005","journal-title":"RoFo"},{"key":"bib8-20230930","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.jemermed.2014.09.060","article-title":"Accuracy of optic nerve sheath diameter measurement by emergency physicians using bedside ultrasound","volume":"48","year":"2015","journal-title":"J Emerg Med"},{"key":"bib9-20230930","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.annemergmed.2006.06.040","article-title":"Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients","volume":"49","year":"2007","journal-title":"Ann Emerg Med"},{"key":"bib10-20230930","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1136\/bjo.87.6.777","article-title":"Architecture of arachnoid trabeculae, pillars, and septa in the subarachnoid space of the human optic nerve: anatomy and clinical considerations","volume":"87","year":"2003","journal-title":"Br J Ophthalmol"},{"key":"bib11-20230930","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/S0002-9394(14)73195-2","article-title":"Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers","volume":"116","year":"1993","journal-title":"Am J Ophthalmol"},{"key":"bib12-20230930","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1007\/BF01383383","article-title":"Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension I. Experimental study","volume":"26","year":"1996","journal-title":"Pediatr Radiol"},{"key":"bib13-20230930","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/BF01627611","article-title":"The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath","volume":"18","year":"1996","journal-title":"Surg Radiol Anat"},{"key":"bib14-20230930","doi-asserted-by":"crossref","first-page":"e528","DOI":"10.1111\/j.1755-3768.2011.02159.x","article-title":"Dependence of the optic nerve sheath diameter on acutely applied subarachnoidal pressure\u2014an experimental ultrasound study","volume":"89","year":"2011","journal-title":"Acta Ophthalmol"},{"key":"bib15-20230930","doi-asserted-by":"crossref","first-page":"860.e5","DOI":"10.1016\/j.ajem.2014.12.030","article-title":"Real-time optic nerve sheath diameter reduction measured with bedside ultrasound after therapeutic lumbar puncture in a patient with idiopathic intracranial hypertension","volume":"33","year":"2015","journal-title":"Am J Emerg Med"},{"key":"bib16-20230930","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/jon.12005","article-title":"Optic nerve sonography to monitor treatment efficacy in idiopathic intracranial hypertension: a case report","volume":"23","year":"2013","journal-title":"J Neuroimaging"},{"key":"bib17-20230930","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/j.1553-2712.2007.00031.x","article-title":"Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure","volume":"15","year":"2008","journal-title":"Acad Emerg Med"},{"key":"bib18-20230930","doi-asserted-by":"crossref","first-page":"2062","DOI":"10.1007\/s00134-008-1149-x","article-title":"Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients","volume":"34","year":"2008","journal-title":"Intensive Care Med"},{"key":"bib19-20230930","doi-asserted-by":"crossref","first-page":"R114","DOI":"10.1186\/cc7006","article-title":"Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure","volume":"12","year":"2008","journal-title":"Crit Care"},{"key":"bib20-20230930","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1186\/cc7008","article-title":"Using MRI of the optic nerve sheath to detect elevated intracranial pressure","volume":"12","year":"2008","journal-title":"Crit Care"},{"key":"bib21-20230930","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s00381-012-1937-z","article-title":"Does optic nerve sheath diameter on MRI decrease with clinically improved pediatric hydrocephalus?","volume":"29","year":"2013","journal-title":"Childs Nerv Syst"},{"key":"bib22-20230930","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1111\/j.1399-6576.2011.02432.x","article-title":"Ultrasonography of the optic nerve in neurocritically ill patients","volume":"55","year":"2011","journal-title":"Acta Anaesthesiol Scand"},{"key":"bib23-20230930","first-page":"779","article-title":"Ocular ultrasound to detect intracranial hypertension in trauma patients","volume":"71","year":"2011","journal-title":"J Trauma"},{"key":"bib24-20230930","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1097\/ALN.0b013e318246ea1a","article-title":"Optic nerve sheath diameter used as ultrasonographic assessment of the incidence of raised intracranial pressure in preeclampsia: a pilot study","volume":"116","year":"2012","journal-title":"Anesthesiology"},{"key":"bib25-20230930","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1007\/s12028-011-9606-8","article-title":"Optic nerve ultrasound for the detection of raised intracranial pressure","volume":"15","year":"2011","journal-title":"Neurocrit Care"},{"key":"bib26-20230930","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.injury.2007.09.029","article-title":"Utility of optic nerve ultrasonography in head injury","volume":"39","year":"2008","journal-title":"Injury"},{"key":"bib27-20230930","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1136\/bjo.2009.172890","article-title":"Distal enlargement of the optic nerve sheath in the hyperacute stage of intracerebral haemorrhage","volume":"95","year":"2011","journal-title":"Br J Ophthalmol"},{"key":"bib28-20230930","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1007\/s00134-011-2224-2","article-title":"Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis","volume":"37","year":"2011","journal-title":"Intensive Care Med"},{"key":"bib29-20230930","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1016\/j.ajem.2014.09.014","article-title":"Optic nerve sheath diameter and lumbar puncture opening pressure in nontrauma patients suspected of elevated intracranial pressure","volume":"32","year":"2014","journal-title":"Am J Emerg Med"},{"key":"bib30-20230930","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1197\/aemj.10.4.376","article-title":"Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath","volume":"10","year":"2003","journal-title":"Acad Emerg Med"},{"key":"bib31-20230930","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1136\/emj.2009.087353","article-title":"Ultrasound measurement of optic nerve sheath diameter in patients with a clinical suspicion of raised intracranial pressure","volume":"28","year":"2011","journal-title":"Emerg Med J"},{"key":"bib32-20230930","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/MEJ.0b013e32835105c8","article-title":"Can ocular ultrasound predict intracranial hypertension? A pilot diagnostic accuracy evaluation in a UK emergency department","volume":"20","year":"2013","journal-title":"Eur J Emerg Med"},{"key":"bib33-20230930","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/S0022-3476(97)70102-1","article-title":"Ultrasonography of the optic nerves: clinical application in children with pseudotumor cerebri","volume":"131","year":"1997","journal-title":"J Pediatr"},{"key":"bib34-20230930","doi-asserted-by":"crossref","first-page":"143","DOI":"10.7863\/jum.2005.24.2.143","article-title":"Sonographic evaluation of optic nerve diameter in children with raised intracranial pressure","volume":"24","year":"2005","journal-title":"J Ultrasound Med"},{"key":"bib35-20230930","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1111\/j.1365-3156.2008.02153.x","article-title":"Detection of raised intracranial pressure by ultrasound measurement of optic nerve sheath diameter in African children","volume":"13","year":"2008","journal-title":"Trop Med Int Health"},{"key":"bib36-20230930","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.7863\/ultra.34.7.1285","article-title":"Sonography of the optic nerve sheath diameter for detection of raised intracranial pressure compared to computed tomography: a systematic review and meta-analysis","volume":"34","year":"2015","journal-title":"J Ultrasound Med"},{"key":"bib37-20230930","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1007\/s00134-009-1494-4","article-title":"Optic nerve ultrasound: artifacts and real images","volume":"35","year":"2009","journal-title":"Intensive Care Med"},{"key":"bib38-20230930","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.7863\/ultra.15.14.09039","article-title":"Coronal axis measurement of the optic nerve sheath diameter using a linear transducer","volume":"34","year":"2015","journal-title":"J Ultrasound Med"},{"key":"bib39-20230930","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s00381-008-0713-6","article-title":"Optic nerve sheath ultrasound in the assessment of paediatric hydrocephalus","volume":"25","year":"2009","journal-title":"Childs Nerv Syst"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00006565-201904000-00007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,30]],"date-time":"2023-09-30T08:22:38Z","timestamp":1696062158000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00006565-201904000-00007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":39,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000001034","relation":{},"ISSN":["1535-1815","0749-5161"],"issn-type":[{"value":"1535-1815","type":"electronic"},{"value":"0749-5161","type":"print"}],"subject":[],"published":{"date-parts":[[2019,4]]}}}