Abstract
Background: The aim of this study was to evaluate whether the early assessment of neurological pupil index (NPi) values derived from automated pupillometry could predict neurological outcome after traumatic brain injury (TBI). Methods: Retrospective observational study including adult (>18 years) TBI patients admitted from January 2018 to December 2020, with available NPi on admission. Abnormal NPi was considered if <3. Unfavorable neurological outcome (UO) at hospital discharge was considered for a Glasgow Outcome Scale of 1–3. Results: 100 patients were included over the study period (median age 48 (34–69) years and median GCS on admission 11 (6–15)); 49 (49%) patients had UO. On admission, 20 (20%) patients had an abnormal NPi (NPi < 3); median worst (i.e., from both eyes) NPi was 4.2 (3.2–4.5). Median worst and mean NPi on admission were significantly lower in the UO group than others (3.9 (1.7–4.4) vs. 4.4 (3.7–4.6); p = 0.005–4.0 (2.6–4.5) vs. 4.5 (3.9–4.7); p = 0.002, respectively). The ROC curve for the worst and mean NPi showed a moderate accuracy to predict UO (AUC 0.66 (0.56–0.77); p = 0.005 and 0.68 (0.57–0.78); p = 0.002). However, in a generalized linear model, the prognostic role of NPi on admission was limited. Conclusions: Low NPi on admission has limited prognostic value in TBI.
Highlights
Traumatic brain injury (TBI), with its variety in cerebral consequences, is one of leading causes of global morbidity and death, primarily in European countries [1]
Background: The aim of this study was to evaluate whether the early assessment of neurological pupil index (NPi) values derived from automated pupillometry could predict neurological outcome after traumatic brain injury (TBI)
Unfavorable neurological outcome (UO) at hospital discharge was considered for a Glasgow Outcome Scale of 1–3
Summary
Traumatic brain injury (TBI), with its variety in cerebral consequences (i.e., mild, moderate or severe), is one of leading causes of global morbidity and death, primarily in European countries [1]. The cornerstone of neuromonitoring in this setting remains neurological examination, which is often simplified using clinical scales, together with the initial assessment of brain injuries [3,4]. The evaluation of pupillary function (i.e., pupillary size, symmetry and the pupillary light reflex, PLR) can give an estimation of brainstem function and/or impelling herniation (i.e., anisocoria, fixed mydriasis, lack of PLR) [5,6] and has been introduced into extensive prognostic calculators to predict 6-month mortality and neurological outcome in adult patients with moderate to severe TBI on admission [7]. The aim of this study was to evaluate whether the early assessment of neurological pupil index (NPi) values derived from automated pupillometry could predict neurological outcome after traumatic brain injury (TBI). Conclusions: Low NPi on admission has limited prognostic value in TBI
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