Observational studyBMC neurology2022
A differential of the left eye and right eye neurological pupil index is associated with discharge modified Rankin scores in neurologically injured patients.
Observational study in BMC neurology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02804438 (Establishing Normative Data for Pupillometer Assessments in Neuro-Intensive Care), which is not on this map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
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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.
Establishing Normative Data for Pupillometer Assessments in Neuro-Intensive Care
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Prognostic value of automated pupillometry in traumatic brain injury: a systematic review and meta-analysis.Neurosurgical review · 2026Pooled it
- Quantitative pupillometry as a sensitive tool for detecting hydrocephalus-related physiologic burden after aSAH: a prospective feasibility study.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Article
- Persistence of NPi differential predicts outcome at intensive care unit discharge: a single-center retrospective analysis.Journal of anesthesia, analgesia and critical care · 2026Article
- Assessing bedside measures of autonomic nervous system dysregulation in the PICU.Pediatric research · 2025Observational
- Prognostic role of quantitative pupillometry in traumatic brain injury: a scoping review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Article
- Time to maximum pupil constriction is variable in neurocritical care patients.Journal of clinical monitoring and computing · 2025Article
- Automated pupillometry is a predictor of outcome of stroke patients: an observational, prospective, cohort study.Brain communications · 2025Article
- There Is Significant Within-Subject Variation in the Time from Light Stimulus to Maximum Pupil Constriction Among Healthy Controls.Journal of clinical medicine · 2024Article
- Anisocoria After Direct Light Stimulus is Associated with Poor Outcomes Following Acute Brain Injury.Neurocritical care · 2024Article
- Dynamically Normalized Pupillometry for Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage.Critical care explorations · 2024Observational
- Pupillometer-Based Neurological Pupil Index Differential: A Potential Predictor of Post-Stroke Delirium.Journal of stroke · 2024Article
- Rapidly Progressive Fatal Pneumococcal Meningitis in a Fully Immunized Child With a History of Facial Bone Fractures.Cureus · 2024Article
- Observational
- Neurological Pupil Index and Delayed Cerebral Ischemia after Subarachnoid Hemorrhage: A Retrospective Multicentric Study.Neurocritical care · 2023Article
- Anisocoria without extraocular muscle impairment due to moderate traumatic brain injury with midbrain contusion: a case report.BMC neurology · 2023Article
- Pupillary Light Response Deficits in 4-Week-Old Piglets and Adolescent Children after Low-Velocity Head Rotations and Sports-Related Concussions.Biomedicines · 2023Article
- Impact of acute intoxication on quantitative pupillometry assessment in the emergency department.Journal of the American College of Emergency Physicians open · 2022Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAutomated infrared pupillometry (AIP) and the Neurological Pupil index (NPi) provide an objective means of assessing and trending the pupillary light reflex (PLR) across a broad spectrum of neurological diseases. NPi quantifies the PLR and ranges from 0 to 5; in healthy individuals, the NPi of both eyes is expected to be ≥ 3.0 and symmetric. AIP values demonstrate emerging value as a prognostic tool with predictive properties that could allow practitioners to anticipate neurological deterioration and recovery. The presence of an NPi differential (a difference ≥ 0.7 between the left and right eye) is a potential sign of neurological abnormality.
methodsWe explored NPi differential by considering the modified Rankin Score at discharge (DC mRS) among patients admitted to neuroscience intensive care units (NSICU) of 4 U.S. and 1 Japanese hospitals and for two cohorts of brain injuries: stroke (including subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, and aneurysm, 1,200 total patients) and 185 traumatic brain injury (TBI) patients for a total of more than 54,000 pupillary measurements.
resultsStroke patients with at least 1 occurrence of an NPi differential during their NSICU stay have higher DC mRS scores (3.9) compared to those without an NPi differential (2.7; P < .001). Patients with TBI and at least 1 occurrence of an NPi differential during their NSICU stay have higher discharge modified Rankin Scale scores (4.1) compared to those without an NPi differential (2.9; P < .001). When patients experience both abnormalities, abnormal (NPi < 3.0) and an NPi differential, the latter has an anticipatory relationship with respect to the former (P < .001 for z-score skewness analysis). Finally, our analysis confirmed ≥ 0.7 as the optimal cutoff value for the NPi differential (AUC = 0.71, P < .001).
conclusionThe NPi differential is an important factor that clinicians should consider when managing critically ill neurological injured patients admitted to the neurocritical care units.
trial registrationNCT02804438 , Date of Registration: June 17, 2016.
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