Underestimation of Pupil Size by Critical Care and Neurosurgical Nurses. - NeurOptics
pupil, pupil exam, pupil examination, pupil pressure measurement, pupil reaction, pupillary, pupillary light reflex, pupillometer, pupillometry, stroke, TBI, trauma, constriction velocity, critical care, critical care nursing, intraocular pressure, modified rankin scale, neurocritical care, neurologist, neuroscience nursing, neurosurgeon, medical devices, NIH Stroke Scoring Scale, NIHSS, ophth, ophthalmic, ophthalmic surgery, ophthalmologist, ophthalmology, opthal, optometrist to ophthalmologist, PERL
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Underestimation of Pupil Size by Critical Care and Neurosurgical Nurses.

Underestimation of Pupil Size by Critical Care and Neurosurgical Nurses.

 

Category: Critical Care

 

Kerr RG1Bacon AM1Baker LL1Gehrke JS1Hahn KD1Lillegraven CL1Renner CH1Spilman SK2. Underestimation of Pupil Size by Critical Care and Neurosurgical Nurses. Am J Crit Care. 2016 May;25(3):213-9. doi: 10.4037/ajcc2016554.

 

Abstract

BACKGROUND:
Early detection of pupillary changes in patients with head injuries can alert the care team to increasing intracranial pressure. Previous research has shown inconsistencies in pupil measurement that are most likely due to the subjective nature of measuring pupils without the assistance of technology.

OBJECTIVES:
To evaluate nurses’ abilities to assess pupil diameter accurately and detect unequal pupils.

METHODS:
In a 3-part study, the accuracy of critical care and neurosurgical nurses’ assessments of pupils was determined. The study included assessment of drawings of eyes with an iris and pupil, examination of photographs of human eyes, and bedside examination of patients with a head injury.

RESULTS:
Subjective assessments of pupil diameter and symmetry were not accurate. Across all phases of the study, pupil diameters were underestimated and the rate of error increased as pupil size increased. Nurses also failed to detect anisocoria and misidentified pupil reactivity. In addition, nearly all nurses relied on subjective estimation, even when tools were available.

CONCLUSIONS:
Critical care and neurosurgical nurses underestimated pupil size, were unable to detect anisocoria, and incorrectly assessedpupil reactivity. Standardized use of pupil assessment tools such as a pupillometer is necessary to increase accuracy and consistency in pupilmeasurement and to potentially contribute to earlier detection of subtle changes in pupils. If pupillary changes are identified early, diagnostic and treatment intervention can be delivered in a more timely and effective manner.