The estimation of pupil size (and reactivity) can be an important part of the acutely ill patient's neurological assessment, a task for ambulance personnel initially then A&E and intensive care staff and ultimately ward staff. The study described here set out first to evaluate variations in the accuracy of the estimation of pupil size by representative samples of these different staff and then to show how, by the application of new technology, such clinical assessment may be automated to ensure consistency, reliability and eventually transmissivity of this important measurement(s).
88 members of representative staff from the North East Ambulance Service, Newcastle General Hospital and Royal Victoria Infirmary were asked to examine 12 artificial eyes (obtained from the National Artificial Eye Service, of varying colour and with 7 different pupillary diameters) in ambient light and without the aid of a pupil size chart. The data collected was entered into a database and analysed to compare the different groups. There was a general under-estimation of pupil size in all groups except ambulance personnel who tended to over-estimate. Intensive care nurses were more accurate than A&E nurses. Doctors, Sisters, Staff Nurses and Student Nurses were similar in their assessment, although interpersonal variation was significant. No significant difference was seen between intensive care nurses in neurosurgical and non-neurosurgical units. Pupil size, colour and shade of the eye had no significant effect on the accuracy of pupil size estimation.
Hooker P, Clark A, Clark TNS, Chambers IR. Pupillary Assessment - acknowledging and overcoming inter-observer variability throughout the patient care pathway. European Journal of Neurosurgery 2002; 144: A17.
Dr. Iain R. Chambers, Cleveland Unit, Middlesbrough. Tel: +44 (0)1642-854-778.
Regional Medical Physics Department, Newcastle General Hospital, Newcastle upon Tyne, NE4 6BE, UK.
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