Abstract TP123: Automated Pupillometry In Large Hemispheric Infarctions And Effects On Therapeutic Interventions - A Retrospective Analysis

Abstract

Background: Cerebral edema is a complication of large hemispheric infarctions (LHI), and automated pupillometry (AP) may be used to monitor for worsening cerebral edema. We hypothesized that AP may recognize earlier clinical deterioration and lead to earlier interventions, ultimately improving outcomes. Methods: This is a retrospective study of acute ischemic stroke patients admitted to a tertiary care hospital from 1/2012-12/2019, with admission imaging of ≥2/3 MCA territory with or without other territory involvement. Patients with AP documented every 4 hours were compared to patients admitted before AP was utilized (2012-2015). Neurologic pupil index (NPi) value <3 and a difference of >0.7 between eyes were recorded along with clinical change, defined as Glasgow coma scale (GCS) decrease of >2. Demographics and hospitalization data were recorded; including mechanical ventilation (MV), hyperosmolar therapy, decompressive hemicraniectomy (DHC), and mortality. Logistic regression was used for association measures. Results: Total of 77 patients were in the AP group (mean age 60, 55% females, mean admission NIHSS was 22, and mean admission GCS 9) and 169 patients in the non-AP group (mean age 64, 55% females, mean admission NIHSS 21, and mean GCS 10.4). Admission GCS was significantly lower in the AP group (p=0.04). There was higher use of MV in the AP group (54 patients, 70%), vs 88 (52%) in the non-AP group (p=0.0084). Hyperosmolar therapy was used more in AP patients (79%), vs 55% in the non-AP group (p=0.0004). There was a trend towards higher rates of DHC in the AP group (35%) compared to the non-AP group (24%), but not significant. Mortality rate was 37% in both groups, and there was no difference in mean discharge modified Rankin scale (mRS). Conclusion: More patients in the AP group were treated with hyperosmolar therapy and underwent DHC, suggesting use of AP may have triggered more therapeutic interventions. The patients in which AP was utilized seemed more critically ill on admission, based on GCS and need for MV; however, the mortality rate and discharge mRS were not significantly different. Prospective studies may determine if using AP in LHI patients would lead to earlier intervention, ultimately improving mortality and morbidity.