Reliability and feasibility of optic nerve point-of-care ultrasound in pediatric patients with ventricular shunts

Purpose To determine the interrater reliability of optic nerve sheath diameter (ONSD) and optic disc elevation (ODE) via ocular ultrasound by emergency and neurosurgery providers in children with ventricular shunts, and to explore the feasibility of acquiring and measuring images. Methods Two novices who underwent focused training and one expert in ocular ultrasound independently acquired images and measured ONSD and ODE on the same children, 0–18 years with ventricular shunts, blinded to each other’s images and measurements. Patient tolerance, image quality, and time-to-complete exams were recorded. Images meeting a priori defined quality metrics were included. Mixed models and bootstrap analysis were used to obtain inter-rater reliability and 95% confidence intervals. Results Eighty-one children were enrolled from August 2016 to July 2017, with mean age 9.6 years (SD 5.25, range 5 months–17.7 years). High-quality images (≥ 4 on 7-point quality Likert scale) were obtained in 83% of ONSD assessments and 95% of ODE assessments. The ICC ONSD was 0.82 (95% CI 0.76–0.91) for right eyes and 0.73 (95% CI 0.69–0.85) for left, while ICC ODE was 0.81 (95% CI 0.75–0.89) for right eyes and 0.85 (95% CI 0.79–0.91) for left. Mean study duration (both eyes) was 2:52 min (SD 54 s). Conclusion Clinicians generated high-quality ocular ultrasound images with excellent interrater reliability when acquiring and measuring images of ONSD and ODE in children with ventricular shunts.