Observational studyNeurocritical care2022
Can Quantitative Pupillometry be used to Screen for Elevated Intracranial Pressure? A Retrospective Cohort Study.
Observational study in Neurocritical care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- Prognostic value of automated pupillometry in traumatic brain injury: a systematic review and meta-analysis.Neurosurgical review · 2026Pooled it
- Non-invasive intracranial pressure estimation in the intensive care unit: narrative review of methods and clinical applications.Intensive care medicine · 2026Review
- Non-invasive ICP monitoring when invasive systems are available in the care of acute brain injured patients: a clinical approach.Journal of anesthesia, analgesia and critical care · 2026Article
- Novel and classic imaging signs of increased intracranial pressure.Neuroradiology · 2025Article
- Is quantitative pupillometry affected by ambient light? A prospective crossover study.Journal of clinical monitoring and computing · 2025Article
- Observational
- Neurological Pupil Index and Intracranial Hypertension in Patients With Acute Brain Injury: A Secondary Analysis of the ORANGE Study.JAMA neurology · 2025Observational
- The Brussels consensus for non-invasive ICP monitoring when invasive systems are not available in the care of TBI patients (the B-ICONIC consensus, recommendations, and management algorithm).Intensive care medicine · 2025Article
- Automated pupillometry is a predictor of outcome of stroke patients: an observational, prospective, cohort study.Brain communications · 2025Article
- Noninvasive Intracranial Pressure Monitoring: Are We There Yet?Neurocritical care · 2024Article
- Artificial Intelligence-Enhanced Neurocritical Care for Traumatic Brain Injury : Past, Present and Future.Journal of Korean Neurosurgical Society · 2024Article
- Article
- The Role of Automated Infrared Pupillometry in Traumatic Brain Injury: A Narrative Review.Journal of clinical medicine · 2024Review
- Article
- Automated pupillometry and optic nerve sheath diameter ultrasound to define tuberculous meningitis disease severity and prognosis.Journal of the neurological sciences · 2023Article
- Neurological Pupil Index and Delayed Cerebral Ischemia after Subarachnoid Hemorrhage: A Retrospective Multicentric Study.Neurocritical care · 2023Article
- Application of Pupillometry in Neurocritical Patients.Journal of personalized medicine · 2023Review
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundElevated intracranial pressure (ICP) is a serious complication in brain injury. Because of the risks involved, ICP is not monitored in all patients at risk. Noninvasive screening tools to identify patients with elevated ICP are needed. Anisocoria, abnormal pupillary size, and abnormal pupillary light reflex are signs of high ICP, but manual pupillometry is arbitrary and subject to interrater variability. We have evaluated quantitative pupillometry as a screening tool for elevated ICP.
methodsWe performed a retrospective observational study of the association between Neurological Pupil index (NPi), measured with the Neuroptics NPi-200 pupillometer, and ICP in patients routinely monitored with invasive ICP measurement in the intensive care unit. We performed a nonparametric receiver operator curve analysis for ICP ≥ 20 mm Hg with NPi as a classification variable. We performed a Youden analysis for the optimal NPi cutoff value and recorded sensitivity and specificity for this cutoff value. We also performed a logistic regression with elevated ICP as the dependent variable and NPi as the independent variable.
resultsWe included 65 patients with invasive ICP monitoring. A total of 2,705 measurements were analyzed. Using NPi as a screening tool for elevated ICP yielded an area under receiver operator curve of 0.72. The optimal mean NPi cutoff value to rule out elevated ICP was ≥ 3.9. The probability of elevated ICP decreased with increasing NPi, with an odds ratio of 0.55 (0.50, 0.61).
conclusionsScreening with NPi may inform high stakes clinical decisions by ruling out elevated ICP with a high degree of certainty. It may also aid in estimating probabilities of elevated ICP. This can help to weigh the risks of initiating invasive ICP monitoring against the risks of not doing so. Because of its ease of use and excellent interrater reliability, we suggest further studies of NPi as a screening tool for elevated ICP.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.