Implementation of Pupillometry Assessment Amongst Severe Traumatic Brain Injured Patients in the Intensive Care Unit
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Authors
Burrows, Kathleen
Issue Date
2023-05-11
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Abstract
Purpose: The purpose of this quality improvement project is to implement a protocol for the pupillometer use for patients with severe traumatic brain injuries in a critical care unit.
Background: Of the 1.7 million people who will suffer from a traumatic brain injury (TBI) each year in the United States, 10-15% of them will be deemed to have a severe one. Up until implementation of pupillometry amongst severe TBI patients, invasive intracranial devices (such as external ventricular drains) were the only objective way to detect further neurological deterioration.
Sample/Setting: The sample includes all patient’s admitted to the ICU with a severe traumatic brain injury (n=5) during a 8 week period. The setting is a 42 bed ICU at a level 1 trauma center.
Problem: Current practice in the intensive care unit does not include the regular use of pupillometry to assess for pupillary changes in patients with severe TBIs.
Objective: To develop and educate on a pilot project for the standardized use of pupillometry in the neurology intensive care unit. Implement the protocol with a target goal of 80% staff compliance utilizing the pupillometer at critical times and notifying providers with critical findings. Staff knowledge of pupillometry will increase pre and post protocol implementation.
Methods: A pre and posttest was administered at the start and finish of the 8-week testing period. Surveillance of compliance with pilot procedure was assessed using audit tools and validated with chart review.
Results and Conclusions: The goal of > 80% compliance with pupillometry was met in 4/5 patients with an overall compliance of 91% of pupillometry use. The overall mortality of patient’s admitted to the ICU with a severe TBI, improved from 53% to 40% compared to data from 2021. The average pre and post score improved by 22.8% and was significant (p value = 0.0009). Pupillometry should continue to be implemented in an evidenced based fashion in the neuro ICU.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University