Prognostic Value of the Neurological Pupil Index in Patients With Acute Subarachnoid Hemorrhage

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Title Prognostic Value of the Neurological Pupil Index in Patients With Acute Subarachnoid Hemorrhage
Creator Rahul A. Sharma; Philip S. Garza; Valérie Biousse; Owen B. Samuels; Nancy J. Newman; Beau B. Bruce
Affiliation Department of Ophthalmology (RAS, PSG, VB, NJN, BBB), Emory University School of Medicine, Atlanta, Georgia; Department of Neurology (VB, NJN), Emory University School of Medicine, Atlanta, Georgia; Department of Neurological Surgery (OBS, NJN), Emory University School of Medicine, Atlanta, Georgia and Department of Epidemiology (BBB), Emory University School of Medicine, Atlanta, Georgia
Abstract Background: The Neurological Pupil index (NPi) provides a quantitative assessment of pupil reactivity and may have prognostic value in patients with subarachnoid hemorrhage (SAH). We aimed to explore associations between the NPi and clinical outcomes in patients with SAH. Methods: A retrospective analysis of 79 consecutive patients with acute SAH. Age, sex, Acute Physiology and Chronic Health Evaluation-II score, and respiratory failure and NPi in each eye were recorded at admission. The primary outcomes included death and poor clinical outcome (defined as inpatient death, care withdrawal, or discharge Glasgow Outcome Score <4). Groups were compared using the Fisher exact test, and predictive models developed with fast-and-frugal trees (FFTs). Results: A total of 53 patients were included: 21 (40%) had poor clinical outcomes and 2 (4%) died. Univariate analysis found that only APACHE-II score (P < 0.001) and respiratory failure (P = 0.04) were significantly associated with poor clinical outcomes. NPi was lower among patients with poor clinical outcomes (mean 4.3 in the right eye and 4.2 in the left eye) vs those without (mean 4.5 in the right eye and 4.5 in the left eye), but neither was significant. However, the most accurate FFTs for death and poor clinical outcome included NPi after accounting for age in the death FFT and APACHE-II score in the poor outcome FFT (sensitivity [sn] = 100%, specificity [sp] = 94%, and accuracy (ac) = 94% in a model for death; sn = 100%, sp = 50%, and ac = 70%) in a model for poor clinical outcome. Conclusions: Our study supports the NPi as a useful prognostic marker for poor outcomes in acute SAH after accounting for age and APACHE-II score.
Subject Prognosis; Pupil; Respiratory Insufficiency; Retrospective Studies; Subarachnoid Hemorrhage
OCR Text Show
Date 2022-06
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, June 2023, Volume 43, Issue 2
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6j8207k
Setname ehsl_novel_jno
ID 2307906
Reference URL https://collections.lib.utah.edu/ark:/87278/s6j8207k
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