| Title: |
Orbital Doppler Ultrasonography and Optic Nerve Sheath Diameter in Pediatric Brain Death Evaluation. |
| Authors: |
Durmuş, Mehmet Ali; Karacan, Alper; Taydaş, Onur; Arslanoğlu, Mehmet Özgür; Yıldız, Zeynep; Paşa, Onur; Taşdoğan, Sinan; Dertli, Tunahan; Tatlı Ayhan, Laçin; Özdemir, Mustafa; Öztürk, Mehmet Halil |
| Source: |
Journal of Clinical Medicine; Apr2026, Vol. 15 Issue 8, p3156, 14p |
| Subject Terms: |
DOPPLER ultrasonography; BRAIN death; PEDIATRIC neurology; CHILD death |
| Abstract: |
Background/Objectives: Brain death determination in children is clinically challenging. When standard clinical examination cannot be completed or reliably interpreted, ancillary testing is required—yet 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(−), 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–Whitney U test with Cliff's 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 0.80–0.90] vs. 0.65 [0.58–0.69]; p < 0.001; δ = 0.975). ROC analysis yielded an AUC of 0.99 (95% CI: 0.96–1.00); at a cut-off of ≥0.77, sensitivity was 95.0% and specificity 100.0%. ONSD also differed significantly between groups (4.75 [4.15–5.08] mm vs. 3.90 [3.40–4.15] mm; p = 0.012; δ = 0.619; AUC = 0.81, 95% CI: 0.62–1.00; cut-off ≥ 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. [ABSTRACT FROM AUTHOR] |
| : |
Copyright of Journal of Clinical Medicine is the property of MDPI and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| Database: |
Complementary Index |