Automated Pupillometry and Its Effects on Management of Intracranial Hemorrhage Patients

Introduction: Automated pupillometry (AP) offers objective data for managing primary spontaneous intracerebral hemorrhage (ICH), but its impact on clinical practice is unclear. We hypothesized that using AP would lead to earlier medical and surgical treatments compared to not using it. This study assessed how AP influenced intervention times and patient outcomes in our Neuro ICU.


Methods: We conducted a retrospective study comparing two groups: a Non-AP group (N=63, from June 2021-Dec 2022) and an AP group (N=30 from 39 qualified patients, from Jan 2023-June 2024). Our primary outcome was the time to first medical therapy. Secondary outcomes included time to surgery, mRS at discharge, mortality, and ICU length of stay (LOS). T-tests and Mann-Whitney U tests were used for comparisons.


Results: There were no significant differences in median age (Non-AP: 63 vs AP: 59.5) or sex (% female: 54.0% vs 36.7%). The AP group had significantly higher baseline ICH Scores(3.20 vs 2.51, p=0.00436). We found no significant difference in the mean time to medical therapy (AP: 30.93h vs Non-AP: 14.85h, p=0.105) or surgery (AP: 21.01h vs Non-AP: 16.92h, p=0.675). Median times were also not different (time to medical therapy: 6.78h vs 5.90h, p=0.567; time to surgical therapy: 2.57h vs 3.61h, p=0.518). Using AP was not linked to better mRS scores (p=0.845), lower mortality (AP: 60.0% vs Non-AP: 41.3%, p=0.0908), or shorter ICU LOS (AP: 16.17d vs Non-AP: 11.87d, p=0.117). Within the AP group, a lower admission NPi Lowest score was significantly linked to a worse mRS at discharge (p=0.0236). The mean (median) time between AP checks (N=19) was 13.3 (12.0) hours.


Conclusions: The under utilization of AP and deviation from our ICU protocol is a limitation but did prompt development and implementation of an AP order. AP was not associated with earlier interventions or better outcomes in our study. This may be in part due to the higher acuity in the AP group. the lowest NPi value proved to be a valuable predictor of patient outcome. Real-world challenges, such as infrequent assessment times and previously identified educational needs for nursing staff and providers likely affected impact of AP use. Future research should adjust for these factors and focus on optimizing how AP is used.