ArticleBMJ open2021
Outcome Prognostication of Acute Brain Injury using the Neurological Pupil Index (ORANGE) study: protocol for a prospective, observational, multicentre, international cohort study.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04490005 (Outcome pRognostication of Acute Brain Injury With the NeuroloGical Pupil), which is not on this map. Cited by 11 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Outcome pRognostication of Acute Brain Injury With the NeuroloGical Pupil
Who cites it
11 citing papers in PubMed, 24 citations in OpenAlex.
- Editor letter for Sanna Holmskär "Is quantitative pupillometry affected by ambient light? A prospective crossover study. J Clin Monit Comput, 2025".Journal of clinical monitoring and computing · 2026Article
- Pupillometry in the Emergency Department: A Tool for Predicting Patient Disposition.The western journal of emergency medicine · 2025Observational
- Examining pupil characteristics and relative afferent pupil defect prevalence in Syrian patients.Annals of medicine and surgery (2012) · 2025Article
- Quantitative Pupillometry Predicts Neurologic Deterioration in Patients with Large Middle Cerebral Artery Stroke.Annals of neurology · 2025Observational
- Observational
- Neurological Pupil Index and Intracranial Hypertension in Patients With Acute Brain Injury: A Secondary Analysis of the ORANGE Study.JAMA neurology · 2025Observational
- Development of an Innovative Pupillometer Able to Selectively Stimulate the Eye's Fundus Photoreceptor Cells.Diagnostics (Basel, Switzerland) · 2024Article
- The Role of Automated Infrared Pupillometry in Traumatic Brain Injury: A Narrative Review.Journal of clinical medicine · 2024Review
- Pupillary dynamics predict long-term outcome in a cohort of acute traumatic brain injury coma patients.Annals of clinical and translational neurology · 2023Article
- Application of Pupillometry in Neurocritical Patients.Journal of personalized medicine · 2023Review
- Neurological Pupil Index for the Early Prediction of Outcome in Severe Acute Brain Injury Patients.Brain sciences · 2022Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe pupillary examination is an important part of the neurological assessment, especially in the setting of acutely brain-injured patients, and pupillary abnormalities are associated with poor outcomes. Currently, the pupillary examination is based on a visual, subjective and frequently inaccurate estimation. The use of automated infrared pupillometry to measure the pupillary light reflex can precisely quantify subtle changes in pupillary functions. The study aimed to evaluate the association between abnormal pupillary function, assessed by the Neurological Pupil Index (NPi), and long-term outcomes in patients with acute brain injury (ABI). METHODS AND ANALYSIS: The Outcome Prognostication of Acute Brain Injury using the Neurological Pupil Index study is a prospective, observational study including adult patients with ABI requiring admission at the intensive care unit. We aimed to recruit at least 420 patients including those suffering from traumatic brain injury or haemorrhagic strokes, over 12 months. The primary aim was to assess the relationship between NPi and 6-month mortality or poor neurological outcome, measured by the Extended Glasgow Outcome Score (GOS-E, poor outcome=GOS-E 1-4). Supervised and unsupervised methods and latent class mixed models will be used to identify patterns of NPi trajectories and Cox and logistic model to evaluate their association with outcome. ETHICS AND DISSEMINATION: The study has been approved by the institutional review board (Comitato Etico Brianza) on 16 July 2020. Approved protocol V.4.0 dated 10 March 2020. The results of this study will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: NCT04490005.
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