{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T09:02:06Z","timestamp":1776762126343,"version":"3.51.2"},"reference-count":20,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Brain death determination in children is clinically challenging. When standard clinical examination cannot be completed or reliably interpreted, ancillary testing is required\u2014yet many established methods depend on infrastructure or patient transport that may not be feasible in critically ill pediatric patients. Orbital ultrasonography is bedside-applicable and non-invasive, but remains poorly characterized in children. Methods: We conducted a single-center retrospective study of 28 pediatric patients evaluated for suspected brain death between January 2021 and February 2025. Patients were classified as brain death-positive [BD(+), n = 20] or brain death-negative [BD(\u2212), n = 8] based on clinical criteria independent of imaging findings. Orbital color Doppler parameters (ophthalmic artery, central retinal artery, posterior ciliary artery) and optic nerve sheath diameter (ONSD) were measured under a standardized protocol by a single experienced operator. Ophthalmic artery resistive index (OA-RI) was defined a priori as the primary outcome; ONSD was the secondary outcome. Group comparisons used the Mann\u2013Whitney U test with Cliff\u2019s delta effect sizes; false discovery rate correction was applied to secondary and exploratory comparisons. ROC analyses were performed to assess discriminative performance. The study was reported in accordance with the STARD 2015 guidelines for diagnostic accuracy research. Results: OA-RI was markedly higher in BD(+) patients (0.84 [IQR 0.80\u20130.90] vs. 0.65 [0.58\u20130.69]; p &lt; 0.001; \u03b4 = 0.975). ROC analysis yielded an AUC of 0.99 (95% CI: 0.96\u20131.00); at a cut-off of \u22650.77, sensitivity was 95.0% and specificity 100.0%. ONSD also differed significantly between groups (4.75 [4.15\u20135.08] mm vs. 3.90 [3.40\u20134.15] mm; p = 0.012; \u03b4 = 0.619; AUC = 0.81, 95% CI: 0.62\u20131.00; cut-off \u2265 4.2 mm; sensitivity and specificity both 75.0%). Across all three orbital vessels, end-diastolic velocity was consistently reduced and resistive indices elevated in BD(+) patients. Systolic velocities did not differ meaningfully between groups. Cut-off values represent cohort-specific statistical optima and should be interpreted as exploratory. Conclusions: Orbital Doppler ultrasonography demonstrates a coherent high-resistance hemodynamic pattern in pediatric brain death. OA-RI showed strong discriminative performance and may serve as a useful bedside adjunct in selected cases where ancillary testing is indicated. ONSD provides complementary anatomical evidence. These findings are exploratory and require prospective validation in larger, multicenter pediatric cohorts.<\/jats:p>","DOI":"10.3390\/jcm15083156","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T07:57:21Z","timestamp":1776758241000},"page":"3156","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Orbital Doppler Ultrasonography and Optic Nerve Sheath Diameter in Pediatric Brain Death Evaluation"],"prefix":"10.3390","volume":"15","author":[{"given":"Mehmet Ali","family":"Durmu\u015f","sequence":"first","affiliation":[{"name":"Department of Radiology, Sakarya University Training and Research Hospital, 54100 Sakarya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8930-9546","authenticated-orcid":false,"given":"Alper","family":"Karacan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sakarya University Training and Research Hospital, 54100 Sakarya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9881-7240","authenticated-orcid":false,"given":"Onur","family":"Tayda\u015f","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sakarya University Training and Research Hospital, 54100 Sakarya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet \u00d6zg\u00fcr","family":"Arslano\u011flu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care, Sakarya University Training and Research Hospital, 54100 Sakarya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7656-6321","authenticated-orcid":false,"given":"Zeynep","family":"Y\u0131ld\u0131z","sequence":"additional","affiliation":[{"name":"Department of Radiology, Gaziantep City Hospital, 27470 Gaziantep, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Onur","family":"Pa\u015fa","sequence":"additional","affiliation":[{"name":"Department of Radiology, A\u011fr\u0131 Training and Research Hospital, 04100 A\u011fr\u0131, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sinan","family":"Ta\u015fdo\u011fan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sakarya University Training and Research Hospital, 54100 Sakarya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tunahan","family":"Dertli","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sakarya University Training and Research Hospital, 54100 Sakarya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4211-7958","authenticated-orcid":false,"given":"La\u00e7in","family":"Tatl\u0131 Ayhan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sakarya University Training and Research Hospital, 54100 Sakarya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1934-5346","authenticated-orcid":false,"given":"Mustafa","family":"\u00d6zdemir","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sakarya University Training and Research Hospital, 54100 Sakarya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet Halil","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sakarya University Training and Research Hospital, 54100 Sakarya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1212\/WNL.96.15_supplement.1173","article-title":"Variability in Pediatric Brain Death Protocols in the United States (1173)","volume":"96","author":"Kirschen","year":"2021","journal-title":"Neurology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e200189","DOI":"10.1212\/CPJ.0000000000200189","article-title":"The 2023 AAN\/AAP\/CNS\/SCCM Pediatric and Adult Brain Death\/Death by Neurologic Criteria Consensus Practice Guideline","volume":"13","author":"Lewis","year":"2023","journal-title":"Neurol. 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