Ayda Kebapcı1, Serpil Topçu2. 1. Koç University School of Nursing, Davutpaşa Street, No: 4, 34010, Topkapı, Istanbul, Turkey. Electronic address: akebapci@ku.edu.tr. 2. Koç University School of Nursing, Davutpaşa Street, No: 4, 34010, Topkapı, Istanbul, Turkey. Electronic address: serpilakkustopcu@gmail.com.
Abstract
BACKGROUND: Pupillary abnormalities are a common and reliable finding of brain herniation, ischaemia, and acute brain injury in critically ill patients. Reliable pupil assessment is a vital evaluation in diagnostic and therapeutic procedures for neurocritical patients. AIM: To evaluate inter-rater reliability of pupillary assessment among intensive care. METHODS: In this prospective, blind observational study, intensive care nurses and two researchers evaluated the pupil size, reactivity and symmetry of 200 patients with neurosurgery or neurological diseases. A total of 200 pupillary measurement sets were completed independently and blindly. RESULTS: Three observers -two researchers and the nurse- found fair-to-good and excellent agreements in initial pupil size evaluations of right and left pupils, respectively (ICC = 0.70, 95%; ICC = 0.75, 95%). In patients with pupil size ≥4 mm, the observers found fair-to-good agreements in both right and left pupil initial size measurements (ICC = 0.52; ICC = 0.65). Agreement in pupil symmetry was moderated (K = 0.58), and reactivity was near perfect (K = 0.89) between the three observers. CONCLUSION: Although the two researchers found near perfect agreement in pupil size, symmetry and reactivity assessment, two researchers and the nurse found moderate agreement in pupil symmetry and fair-to-good agreement in pre- and post-light stimulation pupil size.
BACKGROUND:Pupillary abnormalities are a common and reliable finding of brain herniation, ischaemia, and acute brain injury in critically illpatients. Reliable pupil assessment is a vital evaluation in diagnostic and therapeutic procedures for neurocritical patients. AIM: To evaluate inter-rater reliability of pupillary assessment among intensive care. METHODS: In this prospective, blind observational study, intensive care nurses and two researchers evaluated the pupil size, reactivity and symmetry of 200 patients with neurosurgery or neurological diseases. A total of 200 pupillary measurement sets were completed independently and blindly. RESULTS: Three observers -two researchers and the nurse- found fair-to-good and excellent agreements in initial pupil size evaluations of right and left pupils, respectively (ICC = 0.70, 95%; ICC = 0.75, 95%). In patients with pupil size ≥4 mm, the observers found fair-to-good agreements in both right and left pupil initial size measurements (ICC = 0.52; ICC = 0.65). Agreement in pupil symmetry was moderated (K = 0.58), and reactivity was near perfect (K = 0.89) between the three observers. CONCLUSION: Although the two researchers found near perfect agreement in pupil size, symmetry and reactivity assessment, two researchers and the nurse found moderate agreement in pupil symmetry and fair-to-good agreement in pre- and post-light stimulation pupil size.