Abstract Details

Title Quantitative Pupillometry in the Early Identification of TBI

Topic Neuro Trauma and Critical Care

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 19-005

Objective Evaluate whether quantitative pupillometry (QP) enhances early identification of traumatic brain injury (TBI) during triage.

Background Early trauma triage for TBI relies on GCS and initial pupillary light reflex (PLR). Bedside PLR is operator-dependent and low-resolution, limiting differentiation of diffuse, focal, and mixed injuries. QP provides objective metrics of autonomic pupillary reflexes, integrating sympathetic–parasympathetic dynamics and cranial nerve function. Leveraging QP may improve detection and subgrouping precision of TBI.

Design/Methods This interim analysis of patients (age 18–88) was conducted with an ongoing prospective, observational, blunt-injury trauma cohort admitted directly to a Level I trauma center. QP is obtained on initial evaluation, alongside clinical assessment of GCS and PLR. Clinical teams assessing GCS and PLR are blinded to the QP results. TBI is defined as a head abbreviated injury score >1. A TBI classification model was derived from backward logistic regression on combined clinical and quantitative pupillometry inputs.

Results

There are 309 patients from April 2024–May 2025(age: 49±19, 74% male, 46% TBI) included in the analysis. There is a difference in median GCS(TBI: 14 (6, 15), non-TBI: 15 (14, 15)) and mean age(TBI: 51±20, non-TBI: 48±19). No differences are noted in PLR-derived pupil size between TBI and non-TBI. By QP, differences are noted with the neurological pupil index(TBI: 3.52±1.38, non-TBI: 4.01±0.77), baseline pupil size(TBI: 3.66±1.19 mm, non-TBI: 3.36±1.04 mm), minimum pupil size(TBI: 2.69±0.73 mm, non-TBI: 2.59±0.75 mm), and pupillary response latency(TBI: 0.26 ±0.06 sec, non-TBI: 0.25±0.04 sec). In multivariate modeling, GCS and QP measurements of pupil size, minimum pupil size, and pupillary response latency were found to be independently associated with TBI.

Conclusions QP features, such as baseline pupil size, minimum pupil size, and pupillary response latency may enhance identification of TBI in the hyperacute resuscitation period. Data collection is continuing, which may also help further refine the relationship and identification of additional TBI subtypes.

Authors/Disclosures
Mayur Somalinga, BA PRESENTER	Mr. Somalinga has nothing to disclose.
yang xiaoyan	The institution of Dr. xiaoyan has received research support from China.
Alexander Piszker, DO	Dr. Piszker has nothing to disclose.
Ryan B. Felix	Mr. Felix has received research support from National Science Foundation. Mr. Felix has received intellectual property interests from a discovery or technology relating to health care.
Kathalyn G. Urquizo, BA	Miss Urquizo has nothing to disclose.
Matthew R. Woodward, DO (University of Maryland Medical Center)	Dr. Woodward has nothing to disclose.
Jamie E. Podell, MD	The institution of Dr. Podell has received research support from University of Maryland, Baltimore Institute for Clinical and Translational Research. The institution of Dr. Podell has received research support from R Adams Cowley Shock Trauma Center.
Meagan Watkins, MD	Dr. Watkins has nothing to disclose.
Bradford Burdette	Mr. Burdette has nothing to disclose.
Ron E. Samet, MD	Dr. Samet has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Butterfly Network Inc. Dr. Samet has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Self-employed.
William Teeter, MD	Dr. Teeter has nothing to disclose.
Peter F. Hu, PhD	Dr. Hu has nothing to disclose.
Neeraj Badjatia, MD (University of Maryland School of Medicine)	The institution of Dr. Badjatia has received research support from NIH/DOD.

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