Draft:Quantitative Pupillometry index
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Pupillary light reflex (PLR) is a vital sign of brain function that can be measured by automated pupillometers. These devices can capture objective data on pupil size and reactivity, which are influenced by various neurological conditions. For example, stroke, primary and secondary brain injury can affect how the pupils respond to light stimuli. A standardized score, such as the Quantitative Pupillometry index, can help clinicians evaluate the PLR more accurately and consistently than manual methods.[1] [2]
Quantitative Pupillometry index (QPi)[edit]
The QPi, or Quantitative Pupillometry index, is a method created by IDMED, that makes the pupillary evaluation objective. A device called NeuroLight measures the patient's pupil (including aspects such as size, percentage amplitude, latency, constriction velocity, detection and evaluation of anisocoria, etc.) and compares it to a standard model of how the pupil reacts to light. The QPi then gives a grade from 0 to 5 based on this comparison. Pupil reactivity is measured numerically to track changes in both pupil size and reactivity over time, similar to other vital signs.
The QPi's numeric scale enables a more precise and consistent analysis and classification of the pupil response than subjective assessment.
Interpreting the Quantitative Pupillometry index (QPi)[edit]
QPi, or Quantitative Pupillometry Index, is the score allowing a quick interpretation of the Pupillary Light Reflex of patients. It is not specific to a clinical situation or a pathology. Its simple calculation allows the practitioner to understand the score without ever hiding the relevance and the veracity of the patient's initial Pupillary Light Reflex.
QPi simply differentiates, on a numerical scale from 0 to 5 the reactivity of the Pupillary Light Reflex (measured with the NeuroLight pupillometer). Each of its 6 values corresponds to a PLR range. It is color-coded at 3 levels (Red, Orange, Green) and includes a commentary to facilitate interpretation.
Validity of score indices in pupillometry[edit]
Automated pupillometry and the QPi score are effective in critical care medicine. Many studies published in peer-reviewed academic journals support this.
- There was a significant correlation between NPi and QPi both at 24 and 48 hours to prognosticate outcome after cardiac arrest.[3]
- Assessment equivalence between pupillometry indices NPi and QPi in acute brain injury patients: a strong (substantial) correlation between NPi and QPi has been found.[4]
- Quantitative PLR is more accurate than standard PLR in predicting outcome of post-anoxic coma, irrespective of temperature and sedation, and has comparable prognostic accuracy than EEG and SSEP.[5]
- Pupillometric measurements had better precision and reproducibility compared with the manual pupillary examination. Based on these data, we conclude that pupillometry monitoring can serve as an important tool in the ICU.[6]
- Standard practice in pupillary monitoring yields inaccurate data. Automated quantitative pupillometry is a more reliable method with which to collect pupillary measurements at the bedside.[7]
- Pupillometry is a reliable technology capable of providing repetitive data on quantitative pupillary function in states of health and disease.[8]
References[edit]
- ^ Couret, David (2016). "Reliability of standard pupillometry practice in neurocritical care: An observational, double-blinded study". Critical Care (London, England). 20. Critical CareCritical CareCritical: 99. doi:10.1186/s13054-016-1239-z. PMC 4828754. PMID 27072310.
- ^ "12th EURONEURO".
- ^ "12th EURONEURO".
- ^ "Programme".
- ^ Suys, T.; Bouzat, P.; Marques-Vidal, P.; Sala, N.; Payen, J. F.; Rossetti, A. O.; Oddo, M. (2014). "Automated quantitative pupillometry for the prognostication of coma after cardiac arrest". Neurocritical Care. 21 (2): 300–308. doi:10.1007/s12028-014-9981-z. PMID 24760270. S2CID 19461539.
- ^ Zafar, S. F.; Suarez, J. I. (2014). "Automated pupillometer for monitoring the critically ill patient: A critical appraisal". Journal of Critical Care. 29 (4): 599–603. doi:10.1016/j.jcrc.2014.01.012. PMID 24613394.
- ^ Couret, D.; Boumaza, D.; Grisotto, C.; Triglia, T.; Pellegrini, L.; Ocquidant, P.; Bruder, N. J.; Velly, L. J. (2016). "Reliability of standard pupillometry practice in neurocritical care: An observational, double-blinded study". Critical Care (London, England). 20: 99. doi:10.1186/s13054-016-1239-z. PMC 4828754. PMID 27072310.
- ^ Taylor, W. R.; Chen, J. W.; Meltzer, H.; Gennarelli, T. A.; Kelbch, C.; Knowlton, S.; Richardson, J.; Lutch, M. J.; Farin, A.; Hults, K. N.; Marshall, L. F. (2003). "Quantitative pupillometry, a new technology: Normative data and preliminary observations in patients with acute head injury. Technical note". Journal of Neurosurgery. 98 (1): 205–213. doi:10.3171/jns.2003.98.1.0205. PMID 12546375.
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