Interrater Reliability of Pupillary Assessments

Olson, DaiWai M.; Stutzman, Sonja E.; Saju, Ciji; Wilson, Margaret E.; Zhao, Weidan; Aiyagari, Venkatesh

doi:10.1007/s12028-015-0182-1

Cited by 178 publications

(127 citation statements)

References 29 publications

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“…Our findings should be cautiously compared with those from previous studies that almost uniquely included neurosurgical patients (4)(5)(6)(7)(8)(9). The prevalence of PAs may vary according to the quality of the pupillary evaluation, which can be challenging at the bedside (2,(10)(11)(12)(13)(14). Indeed, the difference in pupillary diameter between the two eyes should be measured under equal illumination and with vergence and accommodation (2).…”

Section: Discussionmentioning

confidence: 79%

“…This scenario might be very frequent in ICUs, notably because of the routine use of morphine derivatives, which promote the occurrence of miosis (15). Indeed, several reports indicate that opioids given at anesthetic doses likely result in a decreased pupillary light constriction below the threshold of 0.3 mm (12,16,17). Therefore, we cannot rule out the fact that some of areflexia were false positives in our study.…”

Section: Discussionmentioning

confidence: 81%

“…Obviously, this is rarely the case in ICUs. Moreover, clinical examinations performed with a penlight are often unable to detect a light reflex when pupils constrict less than 0.3 mm and/or when pupils are very small (10,12). This scenario might be very frequent in ICUs, notably because of the routine use of morphine derivatives, which promote the occurrence of miosis (15).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we cannot rule out the fact that some of areflexia were false positives in our study. Some PAs could also have been missed because of inadequate examinations or monitoring intervals (12,13,17). To date, the best way to limit misdiagnosis of PAs is probably to objectively measure the size and reactivity of pupils by using a handheld automated pupillometer (11,12,15 17).…”

Section: Discussionmentioning

confidence: 99%

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Pupillary abnormalities in non-selected critically ill patients: an observational study

et al. 2017

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Background: Repeated pupillary examination is a key element of neurologic surveillance in intensive care units (ICU). However, in non-selected critically ill patients, the clinical interest of monitoring pupillary diameter and light reflex is poorly documented. We aimed to determine the prevalence and the etiologies of pupillary abnormalities (PAs) in this ICU patient population. Methods: We performed a prospective, observational study in a medical university affiliated ICU over a 6-month period. All patients with at least one pupillary examination were included. PA was defined as areflexia and/or anisocoria present at the time of ICU admission or occurring during the ICU stay.Results: During the study period, we included 297 patients who had 6±9 pupillary examinations per day (totaling 11,360 pupillary assessments). The majority of patients (n=161, 54%) were admitted to the ICU for acute respiratory or cardiovascular failure. A total of 128 PAs were recorded in 109 patients: 78 areflexia alone (61%), 33 anisocoria alone (26%) and 17 (13%) with associated anisocoria and areflexia. The main causes of PAs were related to acute brain ischemia (n=41, 32%) and sedation/analgesia (n=50, 39%). Among the PAs, 59 (46%) were present upon ICU admission. The etiologies of the PAs at admission did not differ from those occurring during ICU stay (P=NS). Interestingly, 9 (7%) PAs were attributed to ipratropium nebulization in patients with chronic obstructive pulmonary disease exacerbation. Conclusions: The high prevalence of PAs, frequently associated with both brain organic lesions and drug side effects, highlights the clinical interest of pupillary surveillance in non-selected critically ill patients.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pupillary abnormalities in non-selected critically ill patients: an observational study

et al. 2017

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“…1 While early, accurate, and reliable detection of pupillary changes is important, the problem of interobserver variability and varying evaluative schemas associated with manual pupillary observation are well known. 2,3 Recent studies continue to confirm inadequate levels of practitioner agreement in regards to pupillary reactivity when traditional, manual pupillary assessments for patients with neurologic injury are used. 2,3 Pupillometers may represent the next step in the evolution of neurocritical care because they are automated, computer-based, and use infrared digital video technology to objectively measure pupillary size and reactivity.…”

Section: Introductionmentioning

confidence: 99%

Are There Predictive Pupillometry Markers in Determining External Ventricular Device (EVD) Weaning Failure or Success in Subarachnoid Hemorrhage Patients?

Bezner¹,

Nattanmai²,

Katyal³

et al. 2018

Am J Hosp Med

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Introduction: Pupillometers objectively measure constriction (i.e., parasympathetic pathway) and dilation (i.e., sympathetic pathway) velocities of the pupillary reflex. These pathways may be affected by increases in ventricular size due to changes in cerebrospinal fluid (CSF) volume, such as during external ventricular device (EVD) weaning in aneurysmal subarachnoid hemorrhage (aSAH) patients. This pilot study evaluated if changes in pupillary responses could be predictive of EVD weaning failure in aSAH patients. Additionally, we analyzed ventricular size and pupillary reactions in these two groups. Methods: Adult aSAH patients serially monitored with the pupillometer at an academic medical center were included. Patients were grouped into those successfully weaned from the EVD and those who were not. Pupillometer measurements (e.g. changes in constriction and dilation velocities), changes in intracranial pressure (ICP), changes in cerebral aqueduct diameter and 3 rd ventricle diameter (measured via computed tomography head (CTH)) were evaluated between the two groups. Results: Seven patients met the inclusion criteria. Three patients required ventriculoperitoneal shunting. There were no significant differences in the changes in constriction or dilation velocities between the groups. Additionally, there was no significant difference in ICP. There were significant differences between the changes in size of the cerebral aqueduct (p=0.01) and of the third ventricle (p=0.01) on CTH between those who weaned and those who did not. These did not correlate with pupillometer measurements. Conclusions: We did not find predictive value in changes in constriction or dilation velocities or ICP on EVD weaning success in aSAH patients. Changes in the diameter of the third ventricle or cerebral aqueduct may be predictive of EVD weaning and suggests a further avenue for study.

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The Nervous System and Its Associated Disorders

Mallinson

2024

Fundamentals of Applied Pathophysiology for Paramedics

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Interrater Reliability of Pupillary Assessments

Cited by 178 publications

References 29 publications

Pupillary abnormalities in non-selected critically ill patients: an observational study

Pupillary abnormalities in non-selected critically ill patients: an observational study

Are There Predictive Pupillometry Markers in Determining External Ventricular Device (EVD) Weaning Failure or Success in Subarachnoid Hemorrhage Patients?

The Nervous System and Its Associated Disorders

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