ABSTRACT
Aims Raised Intracranial Pressure (ICP) is frequently encountered condition amongst children due to neurological and non-neurological etiologies. It contributes towards 20% of the admissions in our PICU at tertiary care institute of North India. Timely diagnosis of raised intracranial pressure is critical for appropriate management. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is non-invasive point of care tool to recognize raised intracranial pressure however there are very limited studies in pediatric population on this. Aim of this study was to measure the ONSD of children admitted in pediatric intensive care unit (PICU) to identify the difference in ONSD among the pediatric patients with normal and raised ICP and to achieve the cut-off value for diagnosing raised ICP. Methods A Hospital based observational comparative study conducted at PICU of a tertiary care institute of national importance in North India. ONSD measurement of all the patients aged 2-14 years admitted in pediatrics department for >48 hours was done in two phases due to COVID-19 related restrictions in routine admissions for some months. First phase was from 1st January 2020 to 31st March 2021 and second phase started from 15th January 2022. Complete enumeration technique was used for the study. Children receiving treatment for raised ICP based on clinical features (Muir's criteria) and neuroimaging were included in raised ICP group and they were compared with the patients without any signs of raised ICP. Optic nerve sheath diameter was measured in both the groups on Day 1 (i.e. within 24 hours of admission) and Day 2 of admission. Third and last ONSD measurement was done on any day between day 4 and day 7 of admission. On each day, 3 readings were taken from each eye and average of 3 readings was used for final statistical analysis for that particular day. Treating team was unaware of the USG findings throughout the stay of the patient in the department. Results Total 101 patients recruited, among them 16 patients had raised ICP and 85 patients had normal ICP. The mean optic nerve sheath diameter on day 1 was found to be higher in the patients with raised ICP (Mean ONSD = 4.955 +/- 0.80) as compared to those with normal ICP (Mean ONSD = 4.05 +/- 0.43). Their mean difference was 0.90 mm (95% CI 0.07-1.48 p value <0.01). Mean ONSD on day 2 also was higher in raised ICP patients (Mean ONSD = 4.82 +/- 0.73) in comparison to normal ICP patients (Mean ONSD = 4.06 +/- 0.47) which was statistically significant (p value = 0.001). The cut-off ONSD value for detecting the raised ICP was estimated to be 4.35 mm on ROC curve with area under the curve 0.862 (95% CI, 0.721-0.943), sensitivity of 75% and specificity of 76.5%. Conclusion Raised ICP is one of the important neurological entities in children contributing towards significant morbidity. Measurement of ONSD by trans-orbital ultrasound was able to detect raised ICP with excellent discriminatory performance.
ABSTRACT
Aims Imposition of restrictions during COVID-19 pandemic adversely affected access and quality of pediatric consultations leading to increased parental anxiety. During pandemic AIIMS Patna initiated telemedicine-based COVID-19 Children's Helpline 'COViTel' in eastern part of India. The aim of the study was to assess the impact of telehealth services on parents' level of anxiety regarding COVID-19 illness in their children using a newly developed Parental Anxiety Score related to Child health (PASC). Methods A prospective cohort study was conducted on 75 parents seeking teleconsultation on 'COViTel' for children either diagnosed with COVID-19 or having direct contact with a COVID-19 positive case. As there was no existing scoring system to assess parental anxiety related with COVID-19 illness, a 6-item PASC (figure 1) was developed to assess parents anxiety level before and 3 days after pediatric teleconsultation. Ethical clearance was granted by institute ethics committee. Results Demographic details are provided in table 1. Parents had moderate level of anxiety (PASC 8) with highest score on item 6 at the time of registration (table 2). Parental anxiety had significantly reduced (PASC 4.2) after teleconsultation (mean difference= 3.787, 95% CI 2.899-4.674, P<0.01) with maximum reduction on item 2 (mean difference= 1.147 95% CI 0.93-1.36, P<0.01) on paired t-test. Conclusion This is first kind of study proving effectiveness of teleconsultation in mitigating parental anxiety related to COVID-19using a novel PASC score.