Mayur Somalinga1, Shiming Yang1, Alexander Piszker1, Ryan Felix2, Kathalyn Urquizo1, Matthew Woodward3, Jamie Podell1, Meagan Watkins1, Bradford Burdette1, Ron Samet1, William Teeter1, Peter Hu1, Neeraj Badjatia1
1University of Maryland School of Medicine, 2University of Maryland College Park, 3University of Maryland Medical Center
Objective:
Evaluate whether quantitative pupillometry (QP) enhances early identification of traumatic brain injury (TBI) during triage.
Background:
Early trauma triage for TBI relies on GCS and initial pupillary light reflex (PLR). Bedside PLR is operator-dependent and low-resolution, limiting differentiation of diffuse, focal, and mixed injuries. QP provides objective metrics of autonomic pupillary reflexes, integrating sympathetic–parasympathetic dynamics and cranial nerve function. Leveraging QP may improve detection and subgrouping precision of TBI.
Design/Methods:
This interim analysis of patients (age 18–88) was conducted with an ongoing prospective, observational, blunt-injury trauma cohort admitted directly to a Level I trauma center. QP is obtained on initial evaluation, alongside clinical assessment of GCS and PLR. Clinical teams assessing GCS and PLR are blinded to the QP results. TBI is defined as a head abbreviated injury score >1. A TBI classification model was derived from backward logistic regression on combined clinical and quantitative pupillometry inputs.
Results:
There are 309 patients from April 2024–May 2025(age: 49±19, 74% male, 46% TBI) included in the analysis. There is a difference in median GCS(TBI: 14 (6, 15), non-TBI: 15 (14, 15)) and mean age(TBI: 51±20, non-TBI: 48±19). No differences are noted in PLR-derived pupil size between TBI and non-TBI. By QP, differences are noted with the neurological pupil index(TBI: 3.52±1.38, non-TBI: 4.01±0.77), baseline pupil size(TBI: 3.66±1.19 mm, non-TBI: 3.36±1.04 mm), minimum pupil size(TBI: 2.69±0.73 mm, non-TBI: 2.59±0.75 mm), and pupillary response latency(TBI: 0.26 ±0.06 sec, non-TBI: 0.25±0.04 sec). In multivariate modeling, GCS and QP measurements of pupil size, minimum pupil size, and pupillary response latency were found to be independently associated with TBI.
Conclusions:
QP features, such as baseline pupil size, minimum pupil size, and pupillary response latency may enhance identification of TBI in the hyperacute resuscitation period. Data collection is continuing, which may also help further refine the relationship and identification of additional TBI subtypes.
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