Role of Infrared Pupillometry in the evaluation, management and prognosis of traumatic brain injury in children: a systematic review

Abstract

Background: Traumatic brain injury (TBI) is an important cause for morbidity and mortality in children. Pupillometer is a low-cost, easy-to-use device that provides objective measures of pupillary reactivity. This review aims to investigate pupillometry applicability in diagnosis, management, and prognosis of children with TBI. Methods: Publications from 2002 to 2022 were identified from Pubmed and Scopus, with a search ending on 11 December 2022. Eligible articles had to explore infrared pupillometry in pediatric TBI. Titles and abstracts were analyzed, along with citation searching to identify relevant articles for synthesis. Study quality was assessed with National Institute of Health Tools. Results: Seven studies were included, from concussion to severe TBI cases. An inverse correlation between intracranial pressure (ICP) and all pupillary measurements was found, except for latency. All pupillary assessments were progressively lower with the raise of ICP, despite this finding was not consistent in Neurological Pupil index. Concussion was either associated with increased or decreased pupillary measurements. Constriction velocity and latency were the most and the least affected by concussion, respectively. Discussion: Studies' heterogeneity and low sample sizes limit reproducibility. Pupillary measurements made after concussion are not consensual, but we found an inverse correlation between pupillary measurements and ICP. Larger prospective studies are needed.