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Interrater Reliability of Pupillary Assessments

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Abstract

Background

Subjective scoring of pupil reactivity is a fundamental element of the neurological examination for which the pupillometer provides an objective measure.

Methods

This single-blinded observational study examined interrater reliability of pupil exam findings between two practitioners and between practitioners and a pupillometer.

Results

From 2329 paired assessments, the interrater reliability between practitioners was only moderate for pupil size (k = 0.54), shape (k = 0.62), and reactivity (k = 0.40). Only 33.3 % of pupils scored as non-reactive by practitioners were scored as non-reactive by pupillometry.

Conclusions

Despite the strong emphasis placed on the traditional pupil examination, especially for patients with a neurological illness, there is limited interrater reliability for subjective scoring of pupillary assessments. Thus, the use of automated pupillometers should be examined as a potential method to increase the reliability of measuring of pupil reactivity.

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Authors and Affiliations

  1. Department of Neurology & Neurotherapeutics, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8855, USA

    DaiWai M. Olson, Sonja Stutzman, Ciji Saju, Margaret Wilson, Weidan Zhao & Venkatesh Aiyagari

  2. Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA

    Venkatesh Aiyagari

Authors
  1. DaiWai M. Olson
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  2. Sonja Stutzman
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  3. Ciji Saju
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  4. Margaret Wilson
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  5. Weidan Zhao
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  6. Venkatesh Aiyagari
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Corresponding author

Correspondence to DaiWai M. Olson.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Funding

The study received no direct funding. Pupillometers were loaned to the university by Neuroptics Inc., at no cost for the duration of the study.

Additional information

On behalf of The University of Texas Southwestern Medical Center, Neurology & Neurotherapeutics.

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Olson, D.M., Stutzman, S., Saju, C. et al. Interrater Reliability of Pupillary Assessments. Neurocrit Care 24, 251–257 (2016). https://doi.org/10.1007/s12028-015-0182-1

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  • DOI: https://doi.org/10.1007/s12028-015-0182-1

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