Ultra-early neurological pupil index trajectories and clinical outcomes in acute brain injury
By
Yong Soo Kim
Dong-Wan Kang
Hyung Seok Guk
Museong Kim
Heewon Jeong
Huimahn Alex Choi
Sung-Min Cho
Moon-Ku Han
Hee Eun Kim
Dong Keon Lee
Han-Gil Jeong
June 12, 2026
Clinical Scorecard: Early Neurological Pupil Index Patterns and Their Relationship with Clinical Outcomes in Acute Brain Injury
At a Glance
Category Detail
Condition Acute brain injury Key Mechanisms Automated pupillometry and Neurological Pupil Index (NPi) for assessing pupillary light reflexes. Target Population Patients aged 18 years or older with acute brain injury requiring ICU admission. Care Setting Emergency department and intensive care unit.
Key Highlights
ICU mortality rate of 29.8% among 168 patients studied. NPi trajectories categorized into four clusters: Consistently high, Worsened, Recovered, and Consistently low. Worsened and Consistently low NPi groups had higher ICU mortality compared to Consistently high group. NPi trajectories improved predictive accuracy for ICU mortality and 6-month mortality. Automated pupillometry provides a standardized measure of pupillary reactivity. Guideline-Based Recommendations
Diagnosis
Utilize automated pupillometry for objective assessment of neurological status in acute brain injury. Management
Monitor NPi trajectories within the first 24 hours of ED arrival to guide treatment strategies. Monitoring & Follow-up
Assess pupillary light reflexes using automated pupillometry to detect neurological deterioration. Risks
Recognize that neurological deterioration is associated with increased mortality and poor functional outcomes. Patient & Prescribing Data
Patients with acute traumatic brain injury, intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, or ischemic stroke.
Early detection of changes in NPi may enhance risk stratification and outcome prediction.
Clinical Best Practices
Incorporate automated pupillometry into routine assessments for patients with acute brain injury. Conduct repeated assessments of NPi during the hyperacute phase for better outcome prediction. Related Resources & Content
