Critical Care Explorations (2025).
IMPORTANCE: In patients with traumatic brain injury (TBI), baseline pupillary assessment is routine; however, the occurrence rate and clinical significance of pupil abnormalities over the early course of hospitalization remain poorly characterized. OBJECTIVES: To determine whether the occurrence and frequency of pupil abnormalities within the first 72 hours of ICU admission are associated with unfavorable discharge outcomes and to assess whether incorporating this frequency improves the performance of an established prognostic model.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective observational study of adults admitted with a primary diagnosis of TBI to a single tertiary care ICU between 2018 and 2022. Inclusion criteria included at least three quantitative pupillometry assessments within the first 72 hours.
MAIN OUTCOMES AND MEASURES: Quantitative pupillometry was used to calculate the Neurological Pupil index (NPi) at each assessment. Abnormalities were defined as NPi < 3 in either eye, NPi asymmetry ≥ 0.7, or pupil size asymmetry ≥ 1 mm. RESULTS: [Truncated for brevity in this abstract excerpt.] The likelihood ratio test revealed that the IMPACT model plus pupil abnormality frequency had an improved goodness-of-fit compared to the core IMPACT model alone when predicting unfavorable discharge disposition (χ² = 5.24, p = 0.02).
CONCLUSIONS: A higher frequency of pupil abnormalities in the first 72 hours is associated with unfavorable discharge outcomes and enhances IMPACT model prognostication.