ABSTRACT

Background: Pupillary light reflex (PLR) is informative about patients with neurological injury. Automated pupillometry provides discrete variables such as dilation velocity (DV). The objective of this study is to determine association between DV and Glasgow Coma Score (GCS), for patients with acquired brain injury.

Methods: There were 2,208 patients with acquired brain injury, pupillometer readings, and daily GCS values available in our registry. GCS was trichotomized as severe (GCS ≤ 8), moderate (GCS = 9–12), or mild injury (GCS = 13–15). Generalized Linear Mixed Model regression was used to identify correlation between DV and GCS.

Results: Patient mean age was 58.9 years, and 49.11% were female. There were 42,229 observations of GCS and DV. Mean admission GCS was 11.7. In the left eye, there was a statistically significant negative association for mean DV in patients with mild (DV = 0.85 mm/s), moderate (DV = 0.71 mm/s), and severe (DV = 0.48 mm/s) injury (p < .0001). Similar results were noted in the right eye with mild (DV = 0.87 mm/s), moderate (DV = 0.72 mm/s), and severe (DV = 0.50 mm/s) injury (p < .0001).

Conclusion: Higher GCS is associated with faster DV. PLR may provide a biomarker of injury when a neurological exam is limited.

Trial Registration: NCT02804438 (June 17, 2016).

ABBREVIATIONS: GCS: Glasgow Coma Scale; PLR: Pupillary Light Reflex; DV: Dilation velocity; ICP: Intracranial pressure; NPi: Neurological pupil index; mRS: Modified Rankin Score; PCT: Percent change in size (pre and post constriction); Lat: Latency; CV: Constriction velocity; GLMM: Generalized Linear Mixed Model

摘要

背景：瞳孔光反射（PLR）可为神经损伤患者提供丰富的信息。自动瞳孔测定法可提供离散变量，例如扩张速度（DV）。这项研究的目的是确定获得性脑损伤患者的DV与格拉斯哥昏迷评分（GCS）之间的关联。

方法：我们的登记表中有2208例获得性脑损伤，瞳孔计读数和每日GCS值的患者。GCS被分为严重（GCS≤8），中度（GCS = 9-12）或轻度损伤（GCS = 13-15）三类。广义线性混合模型回归用于确定DV和GCS之间的相关性。

结果：患者平均年龄为58.9岁，女性为49.11％。对GCS和DV的观测值为42,229次。平均入学GCS为11.7。在轻度（DV = 0.85 mm / s），中度（DV = 0.71 mm / s）和严重（DV = 0.48 mm / s）损伤的患者中，左眼的平均DV在统计学上具有显着负相关（p <.0001）。在右眼中，轻度（DV = 0.87 mm / s），中度（DV = 0.72 mm / s）和重度（DV = 0.50 mm / s）损伤观察到相似的结果（p <.0001）。

结论：较高的GCS与更快的DV相关。当神经系统检查受到限制时，PLR可能会提供损伤的生物标志。

试用注册：NCT02804438（2016年6月17日）。

缩写：GCS：格拉斯哥昏迷量表；PLR：瞳孔光反射；DV：膨胀速度；ICP：颅内压；NPi：神经学瞳孔指数；mRS：改良的Rankin评分；PCT：尺寸变化百分比（收缩前后）；纬度：延迟；CV：收缩速度；GLMM：广义线性混合模型