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Published on: April 27, 2021
Evaluation of Quantitative Pupillometry in Acute Postinjury Pediatric Concussion
Theodore Heyming1, Chloe Knudsen-Robbins2, John Schomberg3
1CHOC Children's Hospital, Orange, California; Department of Emergency Medicine, University of California, Irvine, California.
Insights
Quantitative pupillometry showed limited utility for diagnosing pediatric concussion acutely. The study found few significant associations, suggesting it may not aid in concussion diagnosis or predicting recovery in children.
Area of Science:
- Pediatric neurology
- Ophthalmology
- Sports medicine
Background:
- Concussions are common in children, yet objective diagnostic tools are lacking.
- Quantitative pupillometry was explored as a potential rapid, objective biomarker.
- This study focused on acute, post-injury pediatric concussion assessment.
Purpose of the Study:
- To investigate the utility of quantitative pupillometry in diagnosing pediatric concussion.
- To assess pupillometry's role in predicting recovery time and symptom improvement.
- To evaluate pupillometry in children presenting within 72 hours of head injury.
Main Methods:
- Prospective case-control study of 126 pediatric participants.
- Pupillary measurements obtained using NeurOptics PLR 3000.
- Included symptom checklists and neurocognitive assessments; analyzed with regression models.
Main Results:
- One significant pupillometry difference: left minimum pupil diameter in 12-18 year-olds.
- Significant associations found for time to 75% recovery (left pupil) and average dilation velocity (left pupil) in specific age groups.
- Pupillometry showed associations with symptom and neurocognitive improvement in certain pediatric age groups.
Conclusions:
- Limited statistically significant associations suggest pupillometry may not be a reliable diagnostic tool for acute pediatric concussion.
- Findings indicate pupillometry may not effectively stratify risk for prolonged recovery in this population.
- Further research may be needed to explore pupillometry's role in pediatric head injuries.
Background:
Although millions of children sustain concussions each year, a rapid and objective test for concussion has remained elusive. The aim of this study was to investigate quantitative pupillometry in pediatric patients in the acute, postinjury setting.
Methods:
This was a prospective case-control study of concussed patients presenting to the emergency department within 72 hours of injury. Pupillary measurements were gathered using NeurOptics' PLR 3000; evaluation included a symptom checklist and neurocognitive assessment. Data were analyzed using descriptive statistics and regression models.
Results:
A total of 126 participants were enrolled. One significant difference in pupillometry between concussed and control participants was found: left minimum pupil diameter in 12- to 18 year-olds (P = 0.02). Models demonstrating odds of a concussion revealed significant associations for time to 75% recovery (T75) of the left pupil in five- to 11-year-olds and average dilation velocity of the left pupil in 12- to 18-year-olds (P = 0.03 and 0.02 respectively). Models predicting symptom improvement showed one significant association: percent change of the right pupil in five-to-11-year-olds (P = 0.02). Models predicting neurocognitive improvement in 12- to 18-year-olds demonstrated significant association in T75 in the left pupil for visual memory, visual motor processing speed, and reaction time (P = 0.002, P = 0.04, P = 0.04).
Conclusions:
The limited statistically significant associations found in this study suggest that pupillometry may not be useful in pediatrics in the acute postinjury setting for either the diagnosis of concussion or to stratify risk for prolonged recovery.
