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Erschienen in: Neurocritical Care 2/2016

17.09.2015 | Original Article

Interrater Reliability of Pupillary Assessments

verfasst von: DaiWai M. Olson, Sonja Stutzman, Ciji Saju, Margaret Wilson, Weidan Zhao, Venkatesh Aiyagari

Erschienen in: Neurocritical Care | Ausgabe 2/2016

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Abstract

Background

Subjective scoring of pupil reactivity is a fundamental element of the neurological examination for which the pupillometer provides an objective measure.

Methods

This single-blinded observational study examined interrater reliability of pupil exam findings between two practitioners and between practitioners and a pupillometer.

Results

From 2329 paired assessments, the interrater reliability between practitioners was only moderate for pupil size (k = 0.54), shape (k = 0.62), and reactivity (k = 0.40). Only 33.3 % of pupils scored as non-reactive by practitioners were scored as non-reactive by pupillometry.

Conclusions

Despite the strong emphasis placed on the traditional pupil examination, especially for patients with a neurological illness, there is limited interrater reliability for subjective scoring of pupillary assessments. Thus, the use of automated pupillometers should be examined as a potential method to increase the reliability of measuring of pupil reactivity.
Literatur
1.
Zurück zum Zitat Greenberg MS, Arredondo N. Handbook of neurosurgery. 6th ed. Lakeland: Greenberg Graphics, Thieme Medical Publishers; 2006. Greenberg MS, Arredondo N. Handbook of neurosurgery. 6th ed. Lakeland: Greenberg Graphics, Thieme Medical Publishers; 2006.
2.
Zurück zum Zitat AANN. AANN Core curriculum for neuroscience nursing. 5th ed. Glenview: American Association of Neurosciene Nurses; 2010. AANN. AANN Core curriculum for neuroscience nursing. 5th ed. Glenview: American Association of Neurosciene Nurses; 2010.
3.
Zurück zum Zitat Campbell WW. DeJong’s The Neurologic examination. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. Campbell WW. DeJong’s The Neurologic examination. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.
4.
Zurück zum Zitat Plum F, Posner JB. The diagnosis of stupor and coma. Ed. 3. ed. Philadelphia: Davis; 1980. Plum F, Posner JB. The diagnosis of stupor and coma. Ed. 3. ed. Philadelphia: Davis; 1980.
5.
Zurück zum Zitat Blumenfeld H. Neuroanatomy through clinical cases. Sunderland: Sinauer; 2002. Blumenfeld H. Neuroanatomy through clinical cases. Sunderland: Sinauer; 2002.
6.
Zurück zum Zitat Marmarou A, Lu J, Butcher I, et al. Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma. 2007;24(2):270–80.CrossRefPubMed Marmarou A, Lu J, Butcher I, et al. Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma. 2007;24(2):270–80.CrossRefPubMed
7.
Zurück zum Zitat Narayan RK, Greenberg RP, Miller JD, et al. Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg. 1981;54(6):751–62.CrossRefPubMed Narayan RK, Greenberg RP, Miller JD, et al. Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg. 1981;54(6):751–62.CrossRefPubMed
8.
Zurück zum Zitat Chesnut RM, Gautille T, Blunt BA, Klauber MR, Marshall LE. The localizing value of asymmetry in pupillary size in severe head injury: relation to lesion type and location. Neurosurgery. 1994;34(5):840–5 (discussion 845–846).CrossRefPubMed Chesnut RM, Gautille T, Blunt BA, Klauber MR, Marshall LE. The localizing value of asymmetry in pupillary size in severe head injury: relation to lesion type and location. Neurosurgery. 1994;34(5):840–5 (discussion 845–846).CrossRefPubMed
9.
Zurück zum Zitat Majdan M, Steyerberg EW, Nieboer D, Mauritz W, Rusnak M, Lingsma HF. Glasgow coma scale motor score and pupillary reaction to predict six-month mortality in patients with traumatic brain injury: comparison of field and admission assessment. J Neurotrauma. 2015;32(2):101–8.CrossRefPubMedPubMedCentral Majdan M, Steyerberg EW, Nieboer D, Mauritz W, Rusnak M, Lingsma HF. Glasgow coma scale motor score and pupillary reaction to predict six-month mortality in patients with traumatic brain injury: comparison of field and admission assessment. J Neurotrauma. 2015;32(2):101–8.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Braakman R, Gelpke GJ, Habbema JD, Maas AI, Minderhoud JM. Systematic selection of prognostic features in patients with severe head injury. Neurosurgery. 1980;6(4):362–70.CrossRefPubMed Braakman R, Gelpke GJ, Habbema JD, Maas AI, Minderhoud JM. Systematic selection of prognostic features in patients with severe head injury. Neurosurgery. 1980;6(4):362–70.CrossRefPubMed
11.
Zurück zum Zitat Ritter AM, Muizelaar JP, Barnes T, et al. Brain stem blood flow, pupillary response, and outcome in patients with severe head injuries. Neurosurgery. 1999;44(5):941–8.CrossRefPubMed Ritter AM, Muizelaar JP, Barnes T, et al. Brain stem blood flow, pupillary response, and outcome in patients with severe head injuries. Neurosurgery. 1999;44(5):941–8.CrossRefPubMed
12.
Zurück zum Zitat Tien HC, Cunha JR, Wu SN, et al. Do trauma patients with a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils have any chance of survival? J Trauma. 2006;60(2):274–8.CrossRefPubMed Tien HC, Cunha JR, Wu SN, et al. Do trauma patients with a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils have any chance of survival? J Trauma. 2006;60(2):274–8.CrossRefPubMed
13.
Zurück zum Zitat Manley GT, Larson MD. Infrared pupillometry during uncal herniation. J Neurosurg Anesthesiol. 2002;14(3):223–8.CrossRefPubMed Manley GT, Larson MD. Infrared pupillometry during uncal herniation. J Neurosurg Anesthesiol. 2002;14(3):223–8.CrossRefPubMed
14.
Zurück zum Zitat Goebert HW Jr. Head injury associated with a dilated pupil. Surg Clin North Am. 1970;50(2):427–32.PubMed Goebert HW Jr. Head injury associated with a dilated pupil. Surg Clin North Am. 1970;50(2):427–32.PubMed
15.
Zurück zum Zitat Clusmann H, Schaller C, Schramm J. Fixed and dilated pupils after trauma, stroke, and previous intracranial surgery: management and outcome. J Neurol Neurosurg Psychiatry. 2001;71(2):175–81.CrossRefPubMedPubMedCentral Clusmann H, Schaller C, Schramm J. Fixed and dilated pupils after trauma, stroke, and previous intracranial surgery: management and outcome. J Neurol Neurosurg Psychiatry. 2001;71(2):175–81.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Andrews BT, Pitts LH. Functional recovery after traumatic transtentorial herniation. Neurosurgery. 1991;29(2):227–31.CrossRefPubMed Andrews BT, Pitts LH. Functional recovery after traumatic transtentorial herniation. Neurosurgery. 1991;29(2):227–31.CrossRefPubMed
17.
Zurück zum Zitat Sakas DE, Bullock MR, Teasdale GM. One-year outcome following craniotomy for traumatic hematoma in patients with fixed dilated pupils. J Neurosurg. 1995;82(6):961–5.CrossRefPubMed Sakas DE, Bullock MR, Teasdale GM. One-year outcome following craniotomy for traumatic hematoma in patients with fixed dilated pupils. J Neurosurg. 1995;82(6):961–5.CrossRefPubMed
18.
Zurück zum Zitat Schallenberg M, Bangre V, Steuhl KP, Kremmer S, Selbach JM. Comparison of the Colvard, Procyon, and Neuroptics pupillometers for measuring pupil diameter under low ambient illumination. J Refract Surg. 2010;26(2):134–43.CrossRefPubMed Schallenberg M, Bangre V, Steuhl KP, Kremmer S, Selbach JM. Comparison of the Colvard, Procyon, and Neuroptics pupillometers for measuring pupil diameter under low ambient illumination. J Refract Surg. 2010;26(2):134–43.CrossRefPubMed
19.
Zurück zum Zitat Zafar SF, Suarez JI. Automated pupillometer for monitoring the critically ill patient: a critical appraisal. J Crit Care. 2014;29(4):599–603.CrossRefPubMed Zafar SF, Suarez JI. Automated pupillometer for monitoring the critically ill patient: a critical appraisal. J Crit Care. 2014;29(4):599–603.CrossRefPubMed
20.
Zurück zum Zitat Meeker M, Du R, Bacchetti P, et al. Pupil examination: validity and clinical utility of an automated pupillometer. J Neurosci Nurs. 2005;37(1):34–40.CrossRefPubMed Meeker M, Du R, Bacchetti P, et al. Pupil examination: validity and clinical utility of an automated pupillometer. J Neurosci Nurs. 2005;37(1):34–40.CrossRefPubMed
21.
Zurück zum Zitat Fountas KN, Kapsalaki EZ, Machinis TG, Boev AN, Robinson JS, Troup EC. Clinical implications of quantitative infrared pupillometry in neurosurgical patients. Neurocrit Care. 2006;5(1):55–60.CrossRefPubMed Fountas KN, Kapsalaki EZ, Machinis TG, Boev AN, Robinson JS, Troup EC. Clinical implications of quantitative infrared pupillometry in neurosurgical patients. Neurocrit Care. 2006;5(1):55–60.CrossRefPubMed
22.
Zurück zum Zitat Munoz Negrete FJ, Rebolleda G. Automated evaluation of the pupil. Arch Soc Esp Oftalmol. 2013;88(4):125–6.CrossRefPubMed Munoz Negrete FJ, Rebolleda G. Automated evaluation of the pupil. Arch Soc Esp Oftalmol. 2013;88(4):125–6.CrossRefPubMed
23.
Zurück zum Zitat Kramer CL, Rabinstein AA, Wijdicks EF, Hocker SE. Neurologist versus machine: is the pupillometer better than the naked eye in detecting pupillary reactivity. Neurocrit Care. 2014;21(2):309–11.CrossRefPubMed Kramer CL, Rabinstein AA, Wijdicks EF, Hocker SE. Neurologist versus machine: is the pupillometer better than the naked eye in detecting pupillary reactivity. Neurocrit Care. 2014;21(2):309–11.CrossRefPubMed
24.
Zurück zum Zitat Witting MD, Goyal D. Interrater reliability in pupillary measurement. Ann Emerg Med. 2003;41(6):832–7.CrossRefPubMed Witting MD, Goyal D. Interrater reliability in pupillary measurement. Ann Emerg Med. 2003;41(6):832–7.CrossRefPubMed
25.
Zurück zum Zitat Wilson SF, Amling JK, Floyd SD, McNair ND. Determining interrater reliability of nurses’ assessments of pupillary size and reaction. J Neurosci Nurs. 1988;20(3):189–92.CrossRefPubMed Wilson SF, Amling JK, Floyd SD, McNair ND. Determining interrater reliability of nurses’ assessments of pupillary size and reaction. J Neurosci Nurs. 1988;20(3):189–92.CrossRefPubMed
26.
Zurück zum Zitat Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMed Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMed
27.
Zurück zum Zitat Gwet KL. Inter-rater reliability using SAS : a practical guide for nominal, ordinal, and interval data. Gaithersburg: Advanced Analytics, LLC; 2010. Gwet KL. Inter-rater reliability using SAS : a practical guide for nominal, ordinal, and interval data. Gaithersburg: Advanced Analytics, LLC; 2010.
28.
Zurück zum Zitat Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005;37(5):360–3.PubMed Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005;37(5):360–3.PubMed
29.
Zurück zum Zitat Chen Y, Kardon RH. Studying the effect of iris mechanics on the pupillary light reflex using brimonidine-induced anisocoria. Invest Ophthalmol Vis Sci. 2013;54(4):2951–8.CrossRefPubMedPubMedCentral Chen Y, Kardon RH. Studying the effect of iris mechanics on the pupillary light reflex using brimonidine-induced anisocoria. Invest Ophthalmol Vis Sci. 2013;54(4):2951–8.CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Chen JW, Gombart ZJ, Rogers S, Gardiner SK, Cecil S, Bullock RM. Pupillary reactivity as an early indicator of increased intracranial pressure: the introduction of the Neurological Pupil index. Surg Neurol Int. 2011;2:82.CrossRefPubMedPubMedCentral Chen JW, Gombart ZJ, Rogers S, Gardiner SK, Cecil S, Bullock RM. Pupillary reactivity as an early indicator of increased intracranial pressure: the introduction of the Neurological Pupil index. Surg Neurol Int. 2011;2:82.CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Song Z, Zheng W, Zhu H, et al. Prediction of coma and anisocoria based on computerized tomography findings in patients with supratentorial intracerebral hemorrhage. Clin Neurol Neurosurg. 2012;114(6):634–8.CrossRefPubMed Song Z, Zheng W, Zhu H, et al. Prediction of coma and anisocoria based on computerized tomography findings in patients with supratentorial intracerebral hemorrhage. Clin Neurol Neurosurg. 2012;114(6):634–8.CrossRefPubMed
33.
Zurück zum Zitat Du R, Meeker M, Bacchetti P, Larson MD, Holland MC, Manley GT. Evaluation of the portable infrared pupillometer. Neurosurgery. 2005;57(1):198–203 (discussion 198–203).CrossRefPubMed Du R, Meeker M, Bacchetti P, Larson MD, Holland MC, Manley GT. Evaluation of the portable infrared pupillometer. Neurosurgery. 2005;57(1):198–203 (discussion 198–203).CrossRefPubMed
Metadaten
Titel
Interrater Reliability of Pupillary Assessments
verfasst von
DaiWai M. Olson
Sonja Stutzman
Ciji Saju
Margaret Wilson
Weidan Zhao
Venkatesh Aiyagari
Publikationsdatum
17.09.2015
Verlag
Springer US
Erschienen in
Neurocritical Care / Ausgabe 2/2016
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-015-0182-1

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