Patients admitted to an ICU require constant monitoring to assess the need for and effectiveness of interventions. Comprehensive serial assessments are important for timely diagnosis, detection of status changes, treatment planning, monitoring patient response, and optimal patient outcomes. 1 The neurologic examination (neuro exam) is a vital part of such assessments. A comprehensive neuro exam includes assessing seven domains: consciousness, injury severity, speech, cranial nerve function, pain, motor function, and sensory function. 2 The neuro exam is performed to assess for deterioration in a patient's consciousness and to detect new focal neurologic deficits, which can happen quickly and may result in worsened short-or long-term morbidity. 3 Documentation is a critical part of team members' communication across shift handoffs and level-ofcare transitions. Yet the degree to which both the performance and the documentation of the neuro exam correlate is not well established. Moreover, while a comprehensive neuro exam is commonly required for patients admitted to a neuroscience ICU, some form of a neuro exam is recommended for patients in all ICUs. 4 There has been little research examining which components of the neuro exam are assessed in the medical ICU (MICU), surgical An observational study reveals differences in charting by RNs versus providers.ICU (SICU), and cardiovascular ICU (CVICU), where patients with primary neurologic problems are admitted less often. 4Study purpose. This study examined documentation practices to identify the frequency and components of the neuro exam typically documented by RNs and by providers when caring for patients in the MICU, SICU, and CVICU. (For this study, providers included medical fellows and resident or attending physicians, NPs, and physician assistants.) BACKGROUNDNeurologic complications can and do occur in patients with or without a primary neurologic diagnosis. 5,6 This includes transient neurologic conditions as well as severe complications. For example, patients admitted to a MICU, SICU, or CVICU are at increased risk for developing delirium secondary to a host of health care-associated events. 7,8 In more extreme cases, a postsurgical CVICU patient could experience acute ischemic stroke, or a MICU patient's level of consciousness could progress to coma as a result of metabolic derangements. 9, 10 Clearly, neuro exams are critical to patient care in every ICU.In the neuroscience ICU, the neuro exam is typically highly detailed, designed to evaluate the functional status of every component of the ner-

Background: Triage and neurological assessment of the 1.7 million traumatic brain injuries occurring annually is often done by nurse practitioners and physician assistants in the emergency department. Subjective assessments, such as the neurological examination that includes evaluation of the pupillary light reflex (PLR), can contain bias. Quantitative pupillometry (QP) standardizes and objectifies the PLR examination. Additional data are needed to determine whether QP can predict neurological changes in a traumatic brain injury (TBI) patient.Purpose: This study examines the effectiveness of QP in predicting neurological decline within 24 hours of admission following acute TBI.Methodology: This prospective, observational, clinical trial used pragmatic sampling to assess PLR in TBI patients using QP within 24 hours of ED admission. Chi-square analysis was used to determine change in patient status, through Glasgow Coma Scale (GCS), at baseline and within 24 hours of admission, to the QP.Results: There were 95 participants included in the analysis; of whom 35 experienced neuroworsening, defined by change in GCS of >2 within the first 24 hours of admission. There was a significant association between an abnormal Neurological Pupil index (NPi), defined as NPi of <3, and neuroworsening (p < .0001). The sensitivity (51.43%) and specificity (91.67%) of abnormal NPi in predicting neuroworsening were varied. Conclusion:There is a strong association between abnormal NPi and neuroworsening in the sample of TBI patients with high specificity and moderate sensitivity.Implications: NPi may be an early indicator of neurological changes within 24 hours of ED admission in patients with TBI.

Background: Over the past 5 decades, advances in neuroimaging have yielded insights into the pathophysiologic mechanisms that cause disorders of consciousness (DoC) in patients with severe brain injuries. Structural, functional, metabolic, and perfusion imaging studies have revealed specific neuroanatomic regions, such as the brainstem tegmentum, thalamus, posterior cingulate cortex, medial prefrontal cortex, and occipital cortex, where lesions correlate with the current or future state of consciousness. Advanced imaging modalities, such as diffusion tensor imaging, resting-state functional magnetic resonance imaging (fMRI), and task-based fMRI, have been used to improve the accuracy of diagnosis and long-term prognosis, culminating in the endorsement of fMRI for the clinical evaluation of patients with DoC in the 2018 US (task-based fMRI) and 2020 European (task-based and resting-state fMRI) guidelines. As diverse neuroimaging techniques are increasingly used for patients with DoC in research and clinical settings, the need for a standardized approach to reporting results is clear. The success of future multicenter collaborations and international trials fundamentally depends on the implementation of a shared nomenclature and infrastructure. Methods: To address this need, the Neurocritical Care Society's Curing Coma Campaign convened an international panel of DoC neuroimaging experts to propose common data elements (CDEs) for data collection and reporting in this field. Results:We report the recommendations of this CDE development panel and disseminate CDEs to be used in neuroimaging studies of patients with DoC.Conclusions: These CDEs will support progress in the field of DoC neuroimaging and facilitate international collaboration.

Purpose: Autonomic dysreflexia (AD) is associated with spinal cord injury, manifesting in symptoms of high blood pressure, bradycardia, headache, diaphoresis, and anxiety. Nurses often manage these symptoms; thus, nursing knowledge of AD is crucial. The purpose of this study was to improve AD nursing knowledge while exploring differences between simulation and didactic learning in nurse education. Design and Methods: This prospective pilot study used two types of learning (simulation vs. didactic) to determine if one was superior to the other regarding nursing knowledge of AD. Nurses were given a pretest, randomized to simulation or didactic learning, and then given a posttest 3 months later. Results: Thirty nurses were enrolled in this study. Seventy-seven percent of nurses held a BSN degree with an average of 15.75 years in nursing. The mean knowledge scores for AD at baseline for the control (13.9 [2.4]) and intervention (15.5 [2.9]) groups were not statistically different ( p = .1118). The mean knowledge scores for AD after either didactic-or simulation-based education for the control (15.5 [4.4]) and intervention (16.5 [3.4]) groups were not statistically different ( p = .5204). Clinical Relevance: Autonomic dysreflexia is a critical clinical diagnosis that requires prompt nursing intervention to prevent threatening consequences. This study focused on how different methods of education best benefited AD knowledge acquisition and how simulation versus didactic learning impacts overall nursing education. Conclusions: As a whole, providing nurses with AD education was helpful in improving their understanding of the syndrome. However, our data suggest that both didactic and simulation are equally effective methods to increase AD knowledge.

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