Observational studyJAMA neurology2025
Neurological Pupil Index and Intracranial Hypertension in Patients With Acute Brain Injury: A Secondary Analysis of the ORANGE Study.
Observational study in JAMA neurology, 2025. 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 15 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.
Outcome pRognostication of Acute Brain Injury With the NeuroloGical Pupil
Who cites it
15 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
- Utilization of Noninvasive Intracranial Pressure Monitoring in Patients with Traumatic Brain Injury Treated in Low-Resource Settings: The Intrigo Study.Neurocritical care · 2026Article
- Comparison of two automated pupillometry indices in patients with acute brain injury: the prospective multicentre LYNX cohort study.Critical care (London, England) · 2026Observational
- How we use the neurological pupil index (NPi).Critical care (London, England) · 2026Article
- Non-invasive ICP assessment: reading physiology, not measuring pressure.Intensive care medicine · 2026Article
- Neuroworsening in traumatic brain injury: A consensus of the Latin American Brain Injury Consortium (LABIC) and the Latin American Federation of Neurosurgical Societies (FLANC) expert group.Neurosurgical review · 2026Article
- 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
- Response to Letter to the Editor for: "The Pupillary Light-Off Reflex in Acute Disorders of Consciousness".Neurocritical care · 2025Article
- Clinical Performance of the Brain4care System for Noninvasive Detection of Intracranial Hypertension.Neurocritical care · 2025Article
- Management of intracranial hypertension with and without invasive intracranial pressure monitoring.World journal of critical care medicine · 2025Review
- Article
- Integrating Dynamic Red Blood Cell Distribution Width Monitoring and β-Blocker Therapy for Mortality Prediction in Intensive Care Unit Cardiomyopathy Patients: A Bayesian Multivariate Joint Model and Machine Learning Study.Diagnostics (Basel, Switzerland) · 2025Article
- Construction and validation of a machine learning based prognostic prediction model for children with traumatic brain injury.Frontiers in pediatrics · 2025Article
- Invasive and non-invasive monitoring in the ICU.Trauma surgery & acute care open · 2025Review
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: Invasive intracranial pressure (ICP) is the standard of care in patients with acute brain injury (ABI) with impaired consciousness. The Neurological Pupil Index (NPi) obtained by automated pupillometry is promising for noninvasively estimating ICP. Objectives: To evaluate the association between repeated NPi and invasive ICP values. Design, Setting, and Participants: This study is a secondary analysis of the Outcome Prognostication of Acute Brain Injury With the Neurological Pupil Index (ORANGE), a multicenter, prospective, observational study of patients with ABI performed from October 1, 2020, to May 31, 2022, with follow-up at 6 months after ABI. The ORANGE study was performed at neurologic intensive care units of tertiary hospitals in Europe and North America. In ORANGE, 514 adult patients receiving mechanical ventilatory support were admitted to the intensive care unit after ABI. Exposure: Invasive ICP monitoring and automated pupillometry assessment every 4 hours during the first 7 days, considered as a standard of care. Main Outcomes and Measures: Association between ICP and NPi values over time, using bayesian joint models, with linear and logistic mixed-effects longitudinal submodels. Results: The study included 318 adult patients (median [IQR] age, 58 [43-69] years; 187 [58.8%] male) who required intensive care unit admission, intubation, and mechanical ventilatory support due to acute traumatic brain injury (n = 133 [41.8%]), intracerebral hemorrhage (n = 104 [32.7%]), or aneurysmal subarachnoid hemorrhage (n = 81 [25.5%]) and had automatic infrared pupillometry used as part of the standard evaluation practice and ICP monitoring. A total of 8692 ICP measurements were collected, with a median (IQR) of 31 (18-37) evaluations per patient. The median (IQR) NPi and ICP for the study population were 4.1 (3.5-4.5) and 10 (5-14) mm Hg, respectively. In a linear mixed model, the mean change in the NPi value, as a continuous variable, was -0.003 (95% credible interval [CrI], -0.006 to 0.000) for each 1-mm Hg ICP increase. No significant association between ICP and abnormal NPi (<3; odds ratio, 1.01; 95% CrI, 0.99-1.03) or absent NPi (0; odds ratio, 1.03; 95% CrI, 0.99-1.06) was observed. Conclusions and Relevance: Although an abnormal NPi could indicate brainstem dysfunction, in this large and heterogeneous population of patients, NPi values were not significantly associated overall with ICP values. Repeated NPi measurements may not be a sufficient replacement for invasive monitoring. Trial Registration: ClinicalTrials.gov Identifier: NCT04490005.
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