A case study series published in the Journal of Neuroscience of Nursing revealed that automated infrared pupillometry is an accurate tool that provides reliable data in patients with a poor baseline neurological examination after stroke.Clinical Neurology and Neurosurgery published a study that found that intracerebral hemorrhage volume and shift of midline structures correlate with NPi, and abnormalities in NPi can be predicted by hematoma volume and other CT indicators of ICH severity.The NPi and automated pupillometry have recently been included in the updated 2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) as an object measurement supporting brain injury prognosis in patients following cardiac arrest. According to the new American Heart Association (AHA) guidelines, most deaths attributable to post-cardiac arrest brain injury are due to active withdrawal of life-sustaining treatment based on a predicted poor neurological outcome.More than 100 studies published in peer-reviewed academic journals indicate the effectiveness of automated pupillometry and the NPi scale for use in critical care medicine, neurology, neurosurgery, emergency medicine, and applied research settings. Validity of score indices in pupillometry Automated pupillometer (NPi-300 by NeurOptics, Inc.) A difference in NPi between Right and Left pupils of greater than or equal to 0.7 may also be considered an abnormal pupil reading. An NPi score below 3 means the reflex is abnormal, i.e., weaker than a normal pupil response, and values closer to 0 are more abnormal than values closer to 3. However, a value closer to 4.9 is more normal data than a value closer to 3. A score equal to or above 3 means that the pupil measurement falls within the boundaries of normal pupil behavior as defined by the NPi. Neurological Pupil index™ (NPi®) Pupil Reactivity Assessment Scale (NeurOptics, Inc.) Interpreting the Neurological Pupillary index (NPi) Įach NPi measurement taken is rated on a scale ranging from 0 to 4.9. The numeric scale of the NPi allows for a more rigorous interpretation and classification of the pupil response than subjective assessment. Pupil reactivity is express numerically so that changes in both pupil size and reactivity can be trended over time, just like other vital signs. A patient's pupil measurement (including variables such as size, latency, constriction velocity, dilation velocity, etc.) is obtained using a pupillometer, and the measurement is compared against a normative model of pupil reaction to light and automatically graded by the NPi on a scale of 0 to 4.9. The Neurological Pupil index, or NPi, is an algorithm developed by NeurOptics, Inc., that removes subjectivity from the pupillary evaluation. These terms are subjective and applied without a standard clinical protocol or definition. The pupil's reaction is numerically graded, typically on scales from one to three, to translate how brisk the pupillary reflex is. The pupil should dilate again when the light is moved away. Pupil light reactivity is evaluated by shining a light into a patient's eye to make the pupil constrict in reaction to the light. Manual measurement is subjective and prone to error. Pupil size is traditionally measured using a pupil gauge to estimate the diameter in millimeters of the pupil at rest before any light is shone into the eye-pupils should be of similar size.Pupillary evaluation involves the assessment of two components-pupil size and reactivity to light. Automated pupillometers are used to assess an array of objective pupillary variables including size, constriction velocity, latency, and dilation velocity, which are normalized and standardized to compute an indexed score such as the Neurological Pupil index (NPi). Automated assessment of the pupillary light reflex has emerged as an objective means of measuring pupillary reactivity across a range of neurological diseases, including stroke, traumatic brain injury and edema, tumoral herniation syndromes, and sports or war injuries. However, manual pupil measurements (performed using a penlight or ophthalmoscope) have been shown to be subjective, inaccurate, and not repeatable or consistent. Clinicians routinely check the pupils of critically injured and ill patients to monitor neurological status.
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