Neurocritical Care

, Volume 24, Issue 2, pp 251–257 | Cite as

Interrater Reliability of Pupillary Assessments

  • DaiWai M. Olson
  • Sonja Stutzman
  • Ciji Saju
  • Margaret Wilson
  • Weidan Zhao
  • Venkatesh Aiyagari
Original Article



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.


Pupillometry 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.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • DaiWai M. Olson
    • 1
  • Sonja Stutzman
    • 1
  • Ciji Saju
    • 1
  • Margaret Wilson
    • 1
  • Weidan Zhao
    • 1
  • Venkatesh Aiyagari
    • 1
    • 2
  1. 1.Department of Neurology & NeurotherapeuticsThe University of Texas Southwestern Medical CenterDallasUSA
  2. 2.Department of Neurological SurgeryThe University of Texas Southwestern Medical CenterDallasUSA

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