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Published on: November 26, 2019
Interrater Reliability of Pupillary Assessments
DaiWai M Olson1, Sonja Stutzman2, Ciji Saju2
1Department of Neurology & Neurotherapeutics, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8855, USA. daiwai.olson@utsouthwestern.edu.
Background:
Subjective scoring of pupil reactivity is a fundamental element of the neurological examination for which the pupillometer provides an objective measure.
Methods:
This single-blinded observational study examined interrater reliability of pupil exam findings between two practitioners and between practitioners and a pupillometer.
Results:
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.
Conclusions:
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.
