Joshua Smith1, Oliver Flower2, Ashleigh Tracey2, Phil Johnson2. 1. Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards 2065, Australia. Electronic address: jsmi5942@gmail.com. 2. Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards 2065, Australia.
Abstract
BACKGROUND: The assessment of pupil size and reaction to light is a fundamental part of the neurological assessment; however, manual examination is prone to inaccuracies. The use of an automated infrared pupillometer is one strategy to limit error in pupil examination. OBJECTIVE: The main objective was to assess agreement between manual examination and examination using an automated infrared pupillometer in relation to pupil reaction and size in a specialised neurosciences intensive care unit. METHODS: We conducted a single-centre prospective observational study in a specialised tertiary neurosciences intensive care unit. Participants' pupils were examined hourly for 24 h by both manual examination using a pen torch and examination using an automated infrared pupillometer. RESULTS: Twenty-two participants were enrolled. A total of 935 paired pupil observations were obtained for both pupil reaction and size. There was no statistically significant disagreement in assessing pupil reaction (McNemar's test p = 0.106). Percentage agreement was 96.68% for pupil reaction, with Kappa coefficient, 0.841 (95% confidence interval: 0.7864-0.8956). For all participants, the mean difference in pupil size was 0.154 mm, with limits of agreement of -1.294 mm to +1.603 mm. CONCLUSION: There was no significant disagreement between manual and automated pupillometer observations for pupil reaction. The mean difference in measurement of pupil size was small.
BACKGROUND: The assessment of pupil size and reaction to light is a fundamental part of the neurological assessment; however, manual examination is prone to inaccuracies. The use of an automated infrared pupillometer is one strategy to limit error in pupil examination. OBJECTIVE: The main objective was to assess agreement between manual examination and examination using an automated infrared pupillometer in relation to pupil reaction and size in a specialised neurosciences intensive care unit. METHODS: We conducted a single-centre prospective observational study in a specialised tertiary neurosciences intensive care unit. Participants' pupils were examined hourly for 24 h by both manual examination using a pen torch and examination using an automated infrared pupillometer. RESULTS: Twenty-two participants were enrolled. A total of 935 paired pupil observations were obtained for both pupil reaction and size. There was no statistically significant disagreement in assessing pupil reaction (McNemar's test p = 0.106). Percentage agreement was 96.68% for pupil reaction, with Kappa coefficient, 0.841 (95% confidence interval: 0.7864-0.8956). For all participants, the mean difference in pupil size was 0.154 mm, with limits of agreement of -1.294 mm to +1.603 mm. CONCLUSION: There was no significant disagreement between manual and automated pupillometer observations for pupil reaction. The mean difference in measurement of pupil size was small.
Authors: Benjamin Nyholm; Laust Obling; Christian Hassager; Johannes Grand; Jacob Møller; Marwan Othman; Daniel Kondziella; Jesper Kjaergaard Journal: PLoS One Date: 2022-07-28 Impact factor: 3.752