OCULAR SONOGRAPHIC PATTERNS AND ASSOCIATED PREDICTORS OF RAISED INTRACRANIAL PRESSURE AMONG PAEDIATRIC PATIENTS WITH HEAD INJURY ATTENDING MUHIMBILI ORTHOPAEDIC INSTITUTE

ABSTRACT Background: Raised intracranial pressure (ICP) is a life-threatening complication of traumatic brain injury (TBI) in children and demands prompt recognition. Conventional ICP monitoring methods like External Ventricular Drainage, though effective, are invasive and carry procedural risks. Ocular sonography, particularly measurement of the optic nerve sheath diameter (ONSD), offers a non-invasive, accessible alternative for early ICP assessment. However, its utilization in pediatric trauma care remains limited. Objective: To determine the Ocular Sonographic patterns and associated predictors of raised Intracranial Pressure among pediatric patients with head injury attending Muhimbili Orthopedic Institute from June 2024 to March 2025 Materials and Methods: A prospective cross-sectional study was conducted involving 113 pediatric TBI patients (GCS ≤14) recruited through convenience sampling. Clinical data were collected using structured tools. Ocular ultrasound of the right eye was performed using B-mode sonography to measure ONSD 3 mm posterior to the globe. Data analysis was conducted using SPSS v25. Chi-square tests and logistic regression analyses were used to explore associations between clinical features and raised ICP. Results: Among 113 participants (mean age 8.09 years; 69.9% male), 74.3% had moderate TBI. Ocular sonography revealed optic disc elevation in 6.2% of cases; no instances of retinal detachment or vitreous hemorrhage were found. Mean ONSD increased with age. Clinical features such as seizures (68.1%) and vomiting (61.9%) were common, while hydrocephalus (0.9%) and papilledema (1.8%) were rare. Lower GCS scores were significantly associated with suspected raised ICP (p = 0.035), whereas seizures and vomiting lost significance in multivariate analysis. Conclusion: Glasgow Coma Scale score is a significant predictor of raised ICP in pediatric head injury patients. The absence of papilledema and other ocular sonographic patterns does not exclude raised ICP, supporting the utility of ONSD measurement as a rapid, non-invasive screening tool for early ICP assessment in resource-limited settings.