Determinants of Routine Quantitative Pupillometry in Neurocritical Care

Background/Introduction : Manual pupillary light reflex (PLR) assessment is inconsistent, outdated, and unreliable. Even with evidence of the superiority of QP (Quantitative Pupillometry) assessments, use of manual assessment remains commonplace. Aim : This study aims to quantify the use of QP in the NCCU (Neurocritical Care Unit) and examine clinical determinants of routine QP use. It also identifies clinician beliefs and perceptions of acceptability, appropriateness, feasibility, and fidelity of QP use. Methods : This multi-site, period prevalence observational implementation study took place at 2 academic NCCUs. Both sites recorded frequency of QP use and acuity measures of patients receiving QP use over a 2-week period. A REDCap® survey was distributed to NCCU clinicians assessing their perceptions on QP. Results : Site A had higher prevalence of QP utilization than Site B. Multinomial logistic regression modeling indicated patient diagnosis, age, mechanical ventilation, and continuous EEG were factors associated with QP use at Site B, however no association was evident at Site A. Survey results were in support of QP at both sites. Discussion : QP is a useful tool for pupillary assessment, with years of research and the support of clinicians to its utilization. Utilization varied at Sites A and B, even though both were in support of QP overall. Conclusion : This study established baseline estimates of routine use, as well as factors influencing the frequency of QP assessments. Additional research is needed to definitively determine optimal assessment frequency, role that clinical factors may play, as well as impact of QP on patient outcomes.