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Pupillary Light Reflex Variability as a Predictor of Clinical Outcomes in Subarachnoid Hemorrhage

Ortega-Perez, Stefany; Shoyombo, Ifeoluwa; Aiyagari, Venkatesh; Atem, Folefac; Hill, Michelle; Stutzman, Sonja E.; Olson, DaiWai M.

Journal of Neuroscience Nursing: August 2019 - Volume 51 - Issue 4 - p 171–175
doi: 10.1097/JNN.0000000000000443

ABSTRACT BACKGROUND: A change in the pupillary light reflex (PLR) is a sensitive indicator for detecting expanding intracranial lesions. Changes in PLR may be a prognostic marker for patients with intracranial lesions. The purpose of this analysis was to explore how PLR readings, size, constriction velocity (CV), dilation velocity (DV), Neurologic Pupil Index (NPi), and latency predict clinical outcome in patients with subarachnoid hemorrhage. METHODS: This is a secondary analysis of prospectively collected multicenter registry data. The within-subject standard deviation (WSD) of PLR values, NPi, size, CV, DV, and latency were explored as predictors of discharge modified Rankin Scale (mRS) in patients with subarachnoid hemorrhagic. RESULTS: Among 4403 pupillary readings from 82 patients with a diagnosis of subarachnoid hemorrhage, with a mean age of 57.7 years, the admission Glasgow Coma Scale median score was 14 (eye, 4; verbal, 4; motor, 6), and the mRS median was 0 on admission and 4 at discharge. Correlation between standard deviation of PLR values and discharge mRS was moderate and negative (r = −0.3 to −0.47, P < .01). The standard deviations for NPi, size, CV, and DV were significant for predicting discharge mRS (r2 = 0.23–0.28, P < .05) after controlling for admission Glasgow Coma Scale. CONCLUSION: Patients with higher WSD PLR values showed better outcomes (ie, lower mRS at discharge), suggesting that patients with narrower WSD PLR are at a higher risk for poor outcomes.

Correspondence concerning this article should be addressed to Stefany Ortega-Perez, MSc RN, at She is an Assistant Professor, Universidad del Norte, Barranquilla, Colombia.

Ifeoluwa Shoyombo, BS, is Graduate Medical Student, School of Medicine, University of Texas Southwestern, Dallas, TX.

Venkatesh Aiyagari, MD, is Professor, University of Texas Southwestern, Dallas, TX.

Folefac Atem, PhD MS, is Assistant Professor, University of Texas Southwestern, and is Director, Neurocritical Care Unit, Dallas, TX.

Michelle Hill, MS RN AGCNS-BC CNRN CCRN SCRN, is Comprehensive Stroke Program Coordinator, Riverside Methodist Hospital, Columbus, OH.

Sonja E. Stutzman, PhD, is Clinical Research Manager of Neuroscience Nursing Research Center, University of Texas Southwestern, Dallas, TX.

DaiWai M. Olson, PhD RN CCRN FNCS, is Professor, University of Texas Southwestern, Dallas, TX.

V.A., S.E.S., F.A. and D.M.O. receive research support from NeurOptics, Inc. to UT Southwestern to develop the END-PANIC registry. This article has been reviewed, and all potential or actual conflicts have been resolved. D.M.O. is the Editor for the Journal of Neuroscience Nursing. S.E.S. is a guest editor for Nursing Clinics of North America.

The rest of the authors declare no conflicts of interest.

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Online date: June 7, 2019

© 2019 American Association of Neuroscience Nurses