Quantitative pupillometry may be effective assessment tool in emergency setting

Quantitative pupillometry may be a reliable method of assessing clinically intoxicated patients in EDs, per a study published in the Journal of the American College of Emergency Physicians Open.

“Already widely in use in critical care settings and with documented applications in the detection of neurological injuries and determination of efficacy in different interventions, [quantitative pupillometry] may present value to emergency clinicians as a noninvasive, rapid and precise diagnostic approach for use in the detection and treatment of intoxicated patients,” Benjamin S. Abella, MD, MPhil, professor of emergency medicine at the University of Pennsylvania and lead study investigator, and colleagues wrote.

Abella and fellow researchers sought to examine the extent to which different quantitative pupillometry (QP) metrics can be associated with a range of drug classes, as well as to investigate the benefits of QP as a rapid assessment tool of intoxicated individuals within an ED.

The prospective cohort study was undertaken between Feb. 25, 2019, and April 24, 2021, during which 325 adult individuals (median age, 38 years; 34% women; 55% presented with single substance intoxication) diagnosed as clinically intoxicated or deemed to be in withdrawal were enrolled in the EDs of the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center. Of those, 119 patients were included in the final data set.

Abella and colleagues analyzed eight QP metrics from participants, including maximum and minimum pupil diameter, constriction or percent change, maximum constriction velocity, latency of constriction, dilation velocity and Neurological Pupil Index (NPi), a composite metric of the other seven. Researchers compared this data with that of 82 healthy controls (median age, 28 years; 66% women) to produce Z-scores that were combined to generate NPi values.

Researchers reported that NPi values did not differ significantly between control and study groups (4.31 ± 0.32 vs. 4.29 ± 0.49), nor were there significant differences between individuals with or without a urine drug screen positive for opioid use (4.22 ± 0.52 vs. 4.32 ± 0.48). Data additionally showed that, except for latency of constriction, all other QP metrics for the study group were lower relative to controls.

“With approximately 95,000 alcohol-related fatalities annually and over 70,000 opioid-related drug overdose deaths in 2021 alone, emergency medical service agencies and emergency departments face unique challenges associated with the rapid assessment, treatment and monitoring for intoxication,” Abella said in a related release. “This is the first study of intoxicated patients in the emergency department setting to clearly demonstrate that the NPi is a reliable tool for assessing and triaging patients and a useful indicator of neurologic function irrespective of intoxication, including those attributed to opioids.”

Reference:

• New clinical study shows NeurOptics’ Neurological Pupil Index, an important value for assessing brain injury, is unaffected by clinical intoxication. https://www.businesswire.com/news/home/20230110005401/en/New-Clinical-Study-Shows-NeurOptics%E2%80%99-Neurological-Pupil-Index%E2%84%A2-an-Important-Value-for-Assessing-Brain-Injury-is-Unaffected-by-Clinical-Intoxication. Published Jan. 10, 2023. Accessed Jan. 13, 2023.