Interrater Reliability of Pupillary Assessments
- 1.6k Downloads
Subjective scoring of pupil reactivity is a fundamental element of the neurological examination for which the pupillometer provides an objective measure.
This single-blinded observational study examined interrater reliability of pupil exam findings between two practitioners and between practitioners and a pupillometer.
From 2329 paired assessments, the interrater reliability between practitioners was only moderate for pupil size (k = 0.54), shape (k = 0.62), and reactivity (k = 0.40). Only 33.3 % of pupils scored as non-reactive by practitioners were scored as non-reactive by pupillometry.
Despite the strong emphasis placed on the traditional pupil examination, especially for patients with a neurological illness, there is limited interrater reliability for subjective scoring of pupillary assessments. Thus, the use of automated pupillometers should be examined as a potential method to increase the reliability of measuring of pupil reactivity.
KeywordsPupillometry Interrater reliability Neurological illness Traumatic brain injury Pupil assessment
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
The study received no direct funding. Pupillometers were loaned to the university by Neuroptics Inc., at no cost for the duration of the study.
- 1.Greenberg MS, Arredondo N. Handbook of neurosurgery. 6th ed. Lakeland: Greenberg Graphics, Thieme Medical Publishers; 2006.Google Scholar
- 2.AANN. AANN Core curriculum for neuroscience nursing. 5th ed. Glenview: American Association of Neurosciene Nurses; 2010.Google Scholar
- 3.Campbell WW. DeJong’s The Neurologic examination. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.Google Scholar
- 4.Plum F, Posner JB. The diagnosis of stupor and coma. Ed. 3. ed. Philadelphia: Davis; 1980.Google Scholar
- 5.Blumenfeld H. Neuroanatomy through clinical cases. Sunderland: Sinauer; 2002.Google Scholar
- 9.Majdan M, Steyerberg EW, Nieboer D, Mauritz W, Rusnak M, Lingsma HF. Glasgow coma scale motor score and pupillary reaction to predict six-month mortality in patients with traumatic brain injury: comparison of field and admission assessment. J Neurotrauma. 2015;32(2):101–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Gwet KL. Inter-rater reliability using SAS : a practical guide for nominal, ordinal, and interval data. Gaithersburg: Advanced Analytics, LLC; 2010.Google Scholar