![]() ![]() The in-hospital mortality rate was 28% (59/214) the Neurological Pupil index was negatively associated with in-hospital mortality after adjustments for the presence of brain herniation syndrome (adjusted odds ratio = 0.77, 95% CI = 0.62–0.96). The optimal cut-off value of Neurological Pupil index for detecting brain herniation syndrome was < 1.6 (specificity, 91% sensitivity, 49% ). In 214 consecutive patients with hospital-onset unresponsiveness, 37 (17%) had brain herniation syndrome. Demographics, comorbidities, pupillometry parameters including Neurological Pupil index, brain herniation syndrome, in-hospital mortality, and modified Rankin Scale at 3-months were analyzed. Hospital-onset unresponsiveness was defined as a newly developed unresponsive state as assessed by the ACDU (Alert, Confused, Drowsy, and Unresponsive) scale during the hospital stay. This was a registry-based observational study on patients who activated the neurological rapid response team at Asan Medical Center (Seoul, Korea). The objective of this study is to explore whether a quantitative measurement of pupillary light reflexes is useful in detecting brain herniation syndrome and predicting neurological outcomes in patients who developed hospital-onset unresponsiveness after admission for non-neurological reasons. ![]() However, the current method of shining light and subjective description often shows poor reliability. Pupillary examination through pupillary light reflex is the gold standard method in the initial evaluation of unresponsive patients. Patients who develop hospital-onset unresponsiveness should be promptly managed in order to avoid clinical deterioration.
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