One more thought....I am intrigued about your enquiry regarding retinal venous pulsations..Were you referring to routine fundoscopy or some other technique? Would be grateful if you could refer me to any literature describing its role in the setting of pediatric TBI.
We do assess ON sheath diameter using bedside US to evaluate for elevated ICP. If I recall correctly, the data using a cut off of 5 mm is robust in pediatric patients with a subacute illness like VP shunt malfunction. For the acute TBI patient, I am not certain how accurate the measurements would be. In a small study at our ED, the performance characteristics were modest.
[Bedside sonographic measurement of optic nerve sheath diameter as a predictor of increased intracranial pressure in children. Le A, Hoehn ME, Smith ME, Spentzas T, Schlappy D, Pershad J. Ann Emerg Med. 2009 Jun;53(6):785-91.]
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