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Automated pupillometry and the FOUR score - what is the diagnostic benefit in neurointensive care?
Olsen, Markus Harboe; Jensen, Helene Ravnholt; Ebdrup, Søren Røddik; Topp, Nina Hvid; Strange, Ditte Gry; Møller, Kirsten; Kondziella, Daniel.
Afiliação
  • Olsen MH; Department of Neuroanaesthesiology, The Neuroscience Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. oel@oelfam.com.
  • Jensen HR; Department of Neuroanaesthesiology, The Neuroscience Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • Ebdrup SR; Department of Neuroanaesthesiology, The Neuroscience Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • Topp NH; Department of Neuroanaesthesiology, The Neuroscience Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • Strange DG; Department of Neuroanaesthesiology, The Neuroscience Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • Møller K; Department of Neuroanaesthesiology, The Neuroscience Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • Kondziella D; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Acta Neurochir (Wien) ; 162(7): 1639-1645, 2020 07.
Article em En | MEDLINE | ID: mdl-32383011
INTRODUCTION: The Glasgow Coma Scale (GCS) and visual inspection of pupillary function are routine measures to monitor patients with impaired consciousness and predict their outcome in the neurointensive care unit (neuro-ICU). Our aim was to compare more recent measures, i.e. FOUR score and automated pupillometry, to standard monitoring with the GCS and visual inspection of pupils. METHODS: Supervised trained nursing staff examined a consecutive sample of patients admitted to the neuro-ICU of a tertiary referral centre using GCS and FOUR score and assessing pupillary function first by visual inspection and then by automated pupillometry. Clinical outcome was evaluated 6 months after admission using the Glasgow Outcome Scale-Extended. RESULTS: Fifty-six consecutive patients (median age 63 years) were assessed a total of 234 times. Of the 36 patients with at least one GCS score of 3, 13 had a favourable outcome. All seven patients with at least one FOUR score of ≤ 3 had an unfavourable outcome, which was best predicted by a low "brainstem" sub-score. Compared to automated pupillometry, visual assessment underestimated pupillary diameters (median difference, 0.4 mm; P = 0.006). Automated pupillometry detected a preserved pupillary light reflex in 10 patients, in whom visual inspection had missed pupillary constriction. DISCUSSION: Training of nursing staff to implement frequent monitoring of patients in the neuro-ICU with FOUR score and automated pupillometry is feasible. Both measures provide additional clinical information compared to the GCS and visual assessment of pupillary function, most importantly a more granular classification of patients with low levels of consciousness by the FOUR score.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Reflexo Pupilar / Escala de Coma de Glasgow / Cuidados Críticos / Monitorização Fisiológica Tipo de estudo: Diagnostic_studies / Prognostic_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Reflexo Pupilar / Escala de Coma de Glasgow / Cuidados Críticos / Monitorização Fisiológica Tipo de estudo: Diagnostic_studies / Prognostic_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2020 Tipo de documento: Article