Quantitative pupillometry as a potential biomarker in early concussion assessment

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-02-01 DOI:10.1016/j.jocn.2024.111003

Moez M.I. Bashir , DaiWai M. Olson , Natassia T. Miller , Stephen C. Bunt , C. Munro Cullum

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引用次数: 0

Abstract

Background

There are limited objective methods when it comes to identifying and diagnosing concussion. Pupil assessment is performed routinely as a standard-of-care following traumatic brain injury (TBI). Unlike the highly subjective and limited reliability of pupil assessment using penlights and flashlights, Quantitative pupillometry (QP) is an established, valid, and reliable method of pupillary assessment. This study aims to investigate the use of QP values in concussion evaluation.

Methods

This observational study analyzed data collected by the North Texas Concussion Registry (ConTex). ConTex enrolls subjects who are >5-years of age and clinically diagnosed with concussion. Subjects are excluded if they had moderate or severe traumatic brain injury, spinal cord injury with an American Spinal Injury Association score of C or worse, or if the injury occurred > 6 months from enrollment. Data included demographics, medical history, time since concussion, the Sport Concussion Assessment Tool (SCAT5©) post-concussion symptom scale (PCSS), and QP assessment using the PLR3000® (Neuroptics Inc.) hand-held pupillometer. This study identified all subjects clinically diagnosed with concussion who had completed QP assessment, totaling 162. We created tertiles to describe the lowest (0–20), middle (21–43), and the highest (44–113) symptom score groupings to examine QP data.

Results

Of 162 subjects, 88 were female (54.3%), with a mean age of 15.8 (SD=6.9) years. Most (49.4%) occurrences were sport-related injuries. The mean time since injury was 21 (SD=28.6) days. The mean SCAT5 PCSS score was 37.3 (SD=25.6). A significant difference within average and maximum constriction velocities (p=.041 and 0.034, respectively) was found between subjects seen early (<2weeks) versus late (>2weeks) after injury. Pupillometry values were statistically different across SCAT5 PCSS tertiles for anisocoria after light exposure (p=.046).

Conclusions

This exploratory study is among the first to show that certain QP values — latency of constriction, constriction velocity, and average dilation velocity — may be useful in providing objective metrics when evaluating more symptomatic concussion.

查看原文本刊更多论文

定量瞳孔测量作为早期脑震荡评估的潜在生物标志物。

背景：有有限的客观方法，当涉及到识别和诊断脑震荡。作为创伤性脑损伤（TBI）后的标准护理，瞳孔评估是常规进行的。与使用钢笔和手电筒进行瞳孔评估的高度主观和有限的可靠性不同，定量瞳孔测量（QP）是一种成熟、有效和可靠的瞳孔评估方法。本研究旨在探讨QP值在脑震荡评估中的应用。方法：本观察性研究分析了北德克萨斯州脑震荡登记处（ConTex）收集的数据。ConTex招募的受试者年龄在50到50岁之间，临床诊断为脑震荡。如果受试者患有中度或重度创伤性脑损伤，美国脊髓损伤协会评分为C或更差的脊髓损伤，或者在入组后6个月内发生损伤，则受试者被排除。数据包括人口统计学、病史、脑震荡后时间、运动脑震荡评估工具（SCAT5©）脑震荡后症状量表（PCSS）和使用PLR3000®（Neuroptics Inc.）手持式瞳孔计进行的QP评估。本研究确定了所有临床诊断为脑震荡并完成QP评估的受试者，共计162人。我们创建了分位数来描述最低（0-20）、中间（21-43）和最高（44-113）症状评分分组，以检查QP数据。结果：162例患者中，女性88例（54.3%），平均年龄15.8岁（SD=6.9）。大多数（49.4%）为运动相关损伤。平均伤后时间21天（SD=28.6）。SCAT5 PCSS平均评分为37.3分（SD=25.6）。平均收缩速度和最大收缩速度之间的显著差异(p=。041和0.034)，损伤后早期（2周）受试者间差异无统计学意义。光暴露后，SCAT5 PCSS各组的瞳孔测量值有统计学差异（p= 0.046）。结论：这项探索性研究首次表明，某些QP值——收缩潜伏期、收缩速度和平均扩张速度——可能在评估更多症状性脑震荡时提供客观指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.