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Background Pediatric patients and caregivers face numerous challenges throughout their healthcare journey, often experiencing feelings of lost agency and lost voice. Photovoice, a participatory methodology combining photography with storytelling, empowers participants to share their experiences from their own perspective. However, its use in pediatric hospitalizations has been limited. Using Photovoice-informed methods, this study examines how pediatric patients and caregivers experience illness and navigate the healthcare system, helping identify opportunities to improve care. Methods This study was conducted at Lucile Packard Children’s Hospital between July 2022 and April 2024. Pediatric patients and adult caregivers were recruited from inpatient and hospital-based outpatient settings through the Child Life department. Participants captured photographs of their hospital experiences using personal or study-provided cameras. Semi-structured interviews were conducted with participants to explore the meaning behind their photographs. Team-based inductive thematic analysis of the interviews was then conducted to synthesize care recommendations. Results Eight pediatric patients and six adult caregivers participated. Five themes emerged: (1) life before vs. currently vs. after; (2) environment; (3) playing and being a normal kid; (4) joy, gratitude, and appreciating small things; and (5) resilience and mental health. Patients and caregivers described distinct yet complementary perspectives. Children focused primarily on immediate experiences and processing current circumstances, whereas caregivers emphasized broader responsibilities and long-term implications. Participants’ interactions with the hospital environment particularly highlighted these differences. Patients found symbolic meaning in physical objects, while caregivers focused on interpersonal dynamics. Both groups valued the moments depicted in their photos as reminders of strength and progress, though caregivers noted the emotional complexity of certain images representing both suffering and hope. While both groups emphasized the importance of play and normal routines, patients viewed these as enjoyable distractions while caregivers saw them as evidence of healing. Despite these differences, gratitude for ordinary objects and interpersonal support emerged as universal sentiments. Conclusion This study highlights the unique experiences of pediatric patients and adult caregivers in navigating illness and prolonged hospitalization. Our findings emphasize the importance of Photovoice methodology in capturing the nuance of the patient and caregiver experiences as well as further opportunities to improve pediatric care.

The neurological examination has remained key for the detection of worsening in neurocritical care patients, particularly after traumatic brain injury (TBI). New-onset, unreactive anisocoria frequently occurs in such situations, triggering aggressive diagnostic and therapeutic measures to address life-threatening elevations in intracranial pressure (ICP). As such, the field needs objective, unbiased, portable, and reliable methods for quickly assessing such pupillary changes. In this area, quantitative pupillometry (QP) proves promising, leveraging the analysis of different pupillary variables to indirectly estimate ICP. Thus, this scoping review seeks to describe the existing evidence for the use of QP in estimating ICP in adult patients with TBI as compared with invasive methods, which are considered the standard practice. This review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews, with a main search of PubMed and EMBASE. The search was limited to studies of adult patients with TBI published in any language between 2012 and 2022. Eight studies were included for analysis, with the vast majority being prospective studies conducted in high-income countries. Among QP variables, serial rather than isolated measurements of neurologic pupillary index, constriction velocity, and maximal constriction velocity demonstrated the best correlation with invasive ICP measurement values, particularly in predicting refractory intracranial hypertension. Neurologic pupillary index and ICP also showed an inverse relationship when trends were simultaneously compared. As such, QP, when used repetitively, seems to be a promising tool for noninvasive ICP monitoring in patients with TBI, especially when used in conjunction with other clinical and neuromonitoring data.

Introduction Neuromonitoring represents a cornerstone in the comprehensive management of patients with traumatic brain injury (TBI), allowing for early detection of complications such as increased intracranial pressure (ICP) [1]. This has led to a search for noninvasive modalities that are reliable and deployable at bedside. Among these, ultrasonographic optic nerve sheath diameter (ONSD) measurement is a strong contender, estimating ICP by quantifying the distension of the optic nerve at higher ICP values. Thus, this scoping review seeks to describe the existing evidence for the use of ONSD in estimating ICP in adult TBI patients as compared to gold-standard invasive methods. Materials and Methods This review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews, with a main search of PubMed and EMBASE. The search was limited to studies of adult patients with TBI published in any language between 2012 and 2022. Sixteen studies were included for analysis, with all studies conducted in high-income countries. Results All of the studies reviewed measured ONSD using the same probe frequency. In most studies, the marker position for ONSD measurement was initially 3 mm behind the globe, retina, or papilla. A few studies utilized additional parameters such as the ONSD/ETD (eyeball transverse diameter) ratio or ODE (optic disc elevation), which also exhibit high sensitivity and reliability. Conclusion Overall, ONSD exhibits great test accuracy and has a strong, almost linear correlation with invasive methods. Thus, ONSD should be considered one of the most effective noninvasive techniques for ICP estimation in TBI patients.