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Quantitative assessments of pupillary light reflexes in hospital-onset unresponsiveness

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Abstract
Background Patients who develop hospital-onset unresponsiveness should be promptly managed in order to avoid clinical deterioration. Pupillary examination through pupillary light reflex is the gold standard method in the initial evaluation of unresponsive patients. However, the current method of shining light and subjective description often shows poor reliability. The objective of this study is to explore whether a quantitative measurement of pupillary light reflexes is useful in detecting brain herniation syndrome and predicting neurological outcomes in patients who developed hospital-onset unresponsiveness after admission for non-neurological reasons. Methods This was a registry-based observational study on patients who activated the neurological rapid response team at Asan Medical Center (Seoul, Korea). Hospital-onset unresponsiveness was defined as a newly developed unresponsive state as assessed by the ACDU (Alert, Confused, Drowsy, and Unresponsive) scale during the hospital stay. Demographics, comorbidities, pupillometry parameters including Neurological Pupil index, brain herniation syndrome, in-hospital mortality, and modified Rankin Scale at 3-months were analyzed. Results In 214 consecutive patients with hospital-onset unresponsiveness, 37 (17%) had brain herniation syndrome. The optimal cut-off value of Neurological Pupil index for detecting brain herniation syndrome was < 1.6 (specificity, 91% [95% confidence interval (CI) = 86-95]; sensitivity, 49% [95% CI = 32-66]). The in-hospital mortality rate was 28% (59/214); the Neurological Pupil index was negatively associated with in-hospital mortality after adjustments for the presence of brain herniation syndrome (adjusted odds ratio = 0.77, 95% CI = 0.62-0.96). Poor neurological outcomes (modified Rankin Scale >= 4) at 3 months was observed in 76% (152/201) of the patients; the Neurological Pupil index was negatively associated with poor neurological outcomes after adjustments for clinical variables (adjusted odds ratio = 0.67, 95% CI = 0.49-0.90). Conclusions Quantitative measurements of pupillary light reflexes may be useful for early detection of potentially life-threatening neurological conditions in patients with hospital-onset unresponsiveness.
Author(s)
이한빈홍윤희박보빈최소현이현조전상범
Issued Date
2021
Type
Article
Keyword
DiagnosisHospital patientsMedical examinationNeurologic manifestations of general diseasesPredictionPrognosticationPupillary light reflexPupillometryReflexesTesting
DOI
10.1186/s12883-021-02275-9
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7624
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_doaj_primary_oai_doaj_org_article_fc6cf717dc224caead94e3b0a18ebc7d&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Quantitative%20assessments%20of%20pupillary%20light%20reflexes%20in%20hospital-onset%20unresponsiveness&amp;offset=0&amp;pcAvailability=true
Publisher
BMC NEUROLOGY
Location
영국
Language
한국어
ISSN
1471-2377
Citation Volume
21
Citation Number
234
Citation Start Page
0
Citation End Page
0
Appears in Collections:
Medicine > Medicine
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