| Objective:1.To accurately measure the pupil diameter and light reflex rate of adult patients with acute traumatic brain injury and intracerebral hemorrhage using a portable pupil viewer,and to analyze the relationship between different degrees of injury and pupil changes.2.To observe and compare the differences between the traditional visual estimates and the accurate values of the pupil viewer.3.To analyze the pupil diameter and light reflex rate of adult patients with acute traumatic brain injury and intracerebral hemorrhage at the time of first observation in the hospital.Predictive value for clinical outcome at discharge.Methods:From 2021.12 to 2022.12,186 adult patients(123 with traumatic brain injury and 63 with cerebral hemorrhage)were admitted to the Department of Neurosurgery of the Ninth Forty Hospital of the Chinese People’s Liberation Army Joint Security Force(formerly Lanzhou Military Region General Hospital)and diagnosed with traumatic brain injury and intracerebral hemorrhage,and the severity of injury was distinguished as mild,moderate,or heavy according to the Glasgow Coma Scale score.The conventional visual estimates and portable pupil viewer measurements within 24 hours after admission were recorded separately,and the GCS scores were also assessed.The clinical outcome was assessed at discharge using a GOS score of≥3,which was defined as "good prognosis",and a GOS score of<3,which was defined as "poor prognosis",and a subject operating characteristic(ROC)curve to assess SPSS27.0 was used for statistical analysis.Results:1.In patients with traumatic brain injury and intracerebral hemorrhage with bilateral undilated fixed pupils,there was a moderate negative correlation between pupil diameter and GCS score(rs=-0.485,p<0.01),and a significant positive correlation between light reflex rate and GCS score(rs=0.761,p<0.01);pupil diameters of mild,medium and heavy patients were:3.25±0.47mm,3.61 ±0.55mm,4.25±1.11mm,and light reflex rates were:2.12±0.28mm/s,1.63±0.37mm/s,1.07±0.58mm/s,The pupil diameter gradually increased and the light reflex rate gradually decreased as the degree of injury increased(p<0.05);the difference between the sexes of patients with different degrees of injury was not statistically significant(p>0.05),and the pupil diameter and light reflex rate gradually decreased as the age increased(p<0.05).2.There was a significant positive correlation between the pupil observer accurate values and the traditional visual estimates(left:r=0.890;right:r=0.874,p<0.01);the mean value of the difference between the pupil observer accurate values and the traditional visual estimates and interpupillary(left:0.21;right 0.24),the difference was statistically significant(p<0.05).3.The pupil-to-light reflex rate values at the time of first observation on admission had good predictive performance for the clinical outcome of patients with traumatic brain injury and intracerebral hemorrhage discharged from the hospital,with an area under the ROC curve of 0.936(95%CI:0.887-0.948),with a sensitivity of 0.917 and specificity of 0.846,and an optimal cut-off point of 1.325.Conclusion:1.determine the precise pupil diameter and light reflex rate values in patients with mild,moderate,and severe traumatic brain injury and intracerebral hemorrhage,as well as their relationship with Glasgow Coma Score values.2.the admission pupil light reflex rate in patients with traumatic brain injury and intracerebral hemorrhage is a good predictor of their discharge clinical outcomes.3.the pupil viewer measurements are more accurate and reproducible than traditional visual estimates,Reproducibility is higher.The ability of the portable pupil viewer to accurately quantify pupil size and reactivity allows clinicians to further objectively explore intracranial pathological changes in brain-injured patients,showing great potential in the diagnosis,treatment,monitoring and prognosis of brain injury. |
PDF Full Text Request