The Neurological Pupil Index for Outcome Prognostication in People With Acute Brain Injury (Orange): A Prospective, Observational, Multicentre Cohort Study
Published on: October 19, 2023
A new study demonstrates the prognostic value of the Neurological Pupil index (NPi) for monitoring disease progression and predicting outcomes for people with severe non-anoxic acute brain injury. The prospective, observational cohort study, which was conducted in eight countries in Europe and North America, included patients admitted to the intensive care unit after an acute brain injury. A total of 514 patients were enrolled: 224 with TBI, 139 with aneurysmal subarachnoid hemorrhage, and 151 with intracerebral hemorrhage. To calculate the NPi, patients were assessed with an infrared pupillometer every 4 hours for the first week after admission. A total of 40,071 NPi measurements were collected, with values ranging from 0 to 5; scores lower than 3 indicated abnormalities. Among the 497 patients for whom the 6-month outcome – a combination of neurological outcome and mortality – was assessed, 160 (32%) died and 241 (47%) had at least one abnormal NPi reading. This was linked to poor neurological outcome and in-hospital mortality. Based on their findings, the researchers suggest that “[s]imple, automatic, repeat automated pupillometry assessment could improve the continuous monitoring of disease progression and the dynamics of outcome prediction at the bedside.”