Pilot Study of Neurologic Pupil Index as A Predictor of External Ventricular Drain Clamp Trial Failure After Subarachnoid Hemorrhage

Abdulkadir, Kamal; Ahmed, Khalid Mohamed; Venkatachalam, Aardhra M.; Osman, Mohamad; Aoun, Salah G.; Aiyagari, Venkatesh; Schneider, Nathan J.; Hasan-Washington, Heather; Stutzman, Sonja E.; Olson, DaiWai M.

doi:10.1016/j.wneu.2022.04.123

Cited by 7 publications

(2 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This extends our previous knowledge of NPi, which showed that abnormal NPi upon admission for TBI was predictive of an adverse patient outcome (Riker et al, 2020). The results also extend the recent findings of El Ahmadieh et al ( 2021) and Kamal et al (2022), who report that an abnormal NPi finding using QP has high specificity for surgical decision making.…”

Section: Discussionsupporting

confidence: 88%

Pupillary light reflex measured with quantitative pupillometry has low sensitivity and high specificity for predicting neuroworsening after traumatic brain injury

Trent

Vashisht

Novakovic

et al. 2022

J Am Assoc Nurse Pract

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 88%

Pupillary light reflex measured with quantitative pupillometry has low sensitivity and high specificity for predicting neuroworsening after traumatic brain injury

Trent

Vashisht

Novakovic

et al. 2022

J Am Assoc Nurse Pract

Self Cite

View full text Add to dashboard Cite

show abstract

“…It is important to emphasize that the decision of whether to insert a VPS is usually based on the neurological condition and a computed tomography scan of the brain, and no standardized measurements exist to accurately predict when a VPS is required. However, multiple factors apart from the weaning strategy might affect the success of the weaning attempt, such as age, daily EVD output, the severity of the hemorrhage, and the amount of previous wean failures [ 22 , 23 ]. These factors are not or inconsistently reported in the literature of this meta-analysis and may have influenced the decision of which weaning method was chosen in the retrospective studies, which may contain a potential bias.…”

Section: Discussionmentioning

confidence: 99%

Rapid Versus Gradual Weaning of External Ventricular Drain: A Systematic Literature Review and Meta-analysis

et al. 2023

View full text Add to dashboard Cite

The insertion of an external ventricular drain (EVD) is one of the most common neurosurgical procedures. Whether the weaning method (gradual or rapid) influences the ventriculoperitoneal shunt (VPS) insertion rate has not been conclusively established. The aim of this study is to provide a systematic literature review and conduct a meta-analysis of studies comparing gradual with rapid EVD weaning regarding VPS insertion rate. Articles were identified by searching the Pubmed/Medline, Embase, and Web of Science databases throughout October 2022. Two independent researchers assessed the studies for inclusion and quality. We included randomized trials, prospective cohort studies, and retrospective cohort studies, which compared gradual and rapid EVD weaning. The primary outcome was VPS insertion rate, whereas secondary outcomes were EVD-associated infection (EVDAI) rate and length of stay in the hospital and intensive care unit (ICU). Four studies directly comparing rapid versus gradual EVD weaning, with 1337 patients suffering from subarachnoid hemorrhage, were identified and included in the meta-analysis. VPS insertion rate was 28.1% and 32.1% in patients with gradual and rapid EVD weaning, respectively (relative risk 0.85, 95% confidence interval 0.49–1.46, p = 0.56). Further, the EVDAI rate was comparable between the groups (gradual group 11.2%, rapid group 11.5%, relative risk 0.67, 95% confidence interval 0.24–1.89, p = 0.45), whereas length of stay in the ICU and hospital were significantly shorter in the rapid weaning group (2.7 and 3.6 days, respectively; p < 0.01). Rapid EVD weaning seems comparable to gradual EVD weaning concerning VPS insertion rates and EVDAI, whereas hospital and ICU length of stay is significantly reduced.

show abstract

Quantitative Pupillometry: Clinical Applications for the Internist

Figueroa,

Olson,

Kamal

et al. 2024

The American Journal of Medicine

View full text Add to dashboard Cite

Pilot Study of Neurologic Pupil Index as A Predictor of External Ventricular Drain Clamp Trial Failure After Subarachnoid Hemorrhage

Cited by 7 publications

References 40 publications

Pupillary light reflex measured with quantitative pupillometry has low sensitivity and high specificity for predicting neuroworsening after traumatic brain injury

Pupillary light reflex measured with quantitative pupillometry has low sensitivity and high specificity for predicting neuroworsening after traumatic brain injury

Rapid Versus Gradual Weaning of External Ventricular Drain: A Systematic Literature Review and Meta-analysis

Quantitative Pupillometry: Clinical Applications for the Internist

Contact Info

Product

Resources

About