Kiani Iman, Parsaei Mohammadamin, Karimi Hanie, Beikmarzehei Alireza, Fooladi Sarabi Shahnaz, Pezhdam Pegah, Nouri Khoramabadian Mehranoosh, Shahbazi Mojtaba, Masoudi Maryam, Sanjari Moghaddam Hossein
Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Breastfeeding Research Center, Family Health Research Institute, Tehran Univerity of Medical Sciences, Tehran, Iran.
Neurol Sci. 2025 Mar;46(3):1169-1177. doi: 10.1007/s10072-024-07869-y. Epub 2024 Dec 12.
Traumatic brain injury (TBI) is a major cause of global mortality and disability, leading to primary and secondary brain injuries that can result in severe neurological, cognitive, and psychological impairments. Accurate and early prognosis of TBI outcomes is critical, particularly in assessing the risk of neurological decline, intracranial pressure (ICP) changes, and mortality.
This systematic review aims to evaluate the prognostic value of quantitative pupillometry, particularly the Neurological Pupil Index (NPi), in predicting long-term outcomes in TBI patients.
A systematic review was conducted following PRISMA guidelines, with the protocol registered on PROSPERO (CRD42023489079). Databases including PubMed, Scopus, and Embase were searched. Studies were included based on predefined inclusion criteria, focusing on the prognostic accuracy of automated pupillometry in TBI patients. Risk of bias was assessed using the Joanna Briggs Institute (JBI) tool, and evidence quality was evaluated using the Best-Evidence Synthesis approach.
Thirteen studies met the inclusion criteria, with sample sizes ranging from 36 to 2258 participants. The studies demonstrated a consistent association between lower NPi values and increased mortality, poorer functional outcomes, elevated ICP, and the need for emergency interventions. Despite variability in study design and sample sizes, strong evidence supported the use of NPi as a reliable prognostic tool in TBI management.
Automated infrared pupillometry, particularly through NPi measurement, offers important prognostic value in TBI patients. Incorporating NPi into routine clinical practice could improve the accuracy of prognosis and enhance patient management. Future research should focus on standardizing measurement protocols and validating these findings in larger, more diverse cohorts.
创伤性脑损伤（TBI）是全球死亡和残疾的主要原因，会导致原发性和继发性脑损伤，进而可能造成严重的神经、认知和心理障碍。准确且早期预测TBI的预后至关重要，尤其是在评估神经功能衰退风险、颅内压（ICP）变化及死亡率方面。
本系统评价旨在评估定量瞳孔测量法，特别是神经瞳孔指数（NPi），在预测TBI患者长期预后中的价值。
按照PRISMA指南进行系统评价，方案已在PROSPERO（CRD42023489079）上注册。检索了包括PubMed、Scopus和Embase在内的数据库。根据预先定义的纳入标准纳入研究，重点关注自动瞳孔测量法对TBI患者预后的准确性。使用乔安娜·布里格斯研究所（JBI）工具评估偏倚风险，并采用最佳证据综合法评估证据质量。
13项研究符合纳入标准，样本量从36至2258名参与者不等。这些研究表明，较低的NPi值与死亡率增加、功能预后较差、ICP升高以及需要紧急干预之间存在一致的关联。尽管研究设计和样本量存在差异，但有力证据支持将NPi用作TBI管理中的可靠预后工具。
自动红外瞳孔测量法，特别是通过NPi测量，在TBI患者中具有重要的预后价值。将NPi纳入常规临床实践可提高预后准确性并加强患者管理。未来研究应专注于标准化测量方案，并在更大、更多样化的队列中验证这些发现。
