İnterrater reliability in pupillary assessment among intensive care nurses

Abstract

Background: Pupillary abnormalities are a common and reliable finding of brain herniation, ischaemia, and acute brain injury in critically ill patients. Reliable pupil assessment is a vital evaluation in diagnostic and therapeutic procedures for neurocritical patients. aim: To evaluate inter-rater reliability of pupillary assessment among intensive care. Methods: in this prospective, blind observational study, intensive care nurses and two researchers evaluated the pupil size, reactivity and symmetry of 200 patients with neurosurgery or neurological diseases. a total of 200 pupillary measurement sets were completed independently and blindly. Results: Three observers -two researchers and the nurse- found fair-to-good and excellent agreements in initial pupil size evaluations of right and left pupils, respectively (ICC = 0.70, 95%; ICC = 0.75, 95%). in patients with pupil size >= 4 mm, the observers found fair-to-good agreements in both right and left pupil initial size measurements (ICC = 0.52; ICC = 0.65). agreement in pupil symmetry was moderated (K = 0.58), and reactivity was near perfect (K = 0.89) between the three observers. Conclusion: although the two researchers found near perfect agreement in pupil size, symmetry and reactivity assessment, two researchers and the nurse found moderate agreement in pupil symmetry and fair-to-good agreement in pre- and post-light stimulation pupil size. (C) 2020 Elsevier Ltd. .