Correlation of Point of Care Ultrasound (POCUS) Guided Pupillary Assessment Parameter with Glasgow Coma Scale in Patients with Altered Mental Status– A Cross Sectional Study
Bibliographic record
Abstract
Background: Earlier studies have proved deteriorating Glasgow Coma Scale (GCS) as a marker of raised intracranial pressure (ICP). Low GCS is associated with abnormal pupillary parameters. Currently, many studies have proved that ultrasound provides a feasible and objective assessment of pupillary light reflex. However, literature is lacking to evaluate objective pupillary parameters to predict GCS of the patients by point of care ultrasound (POCUS). Materials and methods: In this prospective, cross-sectional study, 200 patients were recruited in the emergency department. The inclusion criteria were patients older than 18 years with acute presentation of altered mental status. Exclusion criteria were patients who had partial globe rupture or dementia. The patients underwent a B-mode POCUS-guided evaluation at rest and after light stimulation. Statistical analysis of relationship between pupillary assessment parameters and GCS was performed using Spearman's Rank correlation coefficient, Kruskal-Wallis equality-of-populations rank test, and area under the receiver operating characteristic. Results: The study consisted of 200 (42 female, 158 male) patients with mean (± standard deviation) of age and GCS of 43.56 ± 16.50 years and 5.54 ± 3.00, respectively. Majority of non-reactive pupils had a GCS Score of 3-8 (74 cases, 97.37%). The Pupillary diameter (PD) and PD variation showed statistically significant agreement with pupil reactivity to light stimulation and GCS, with Spearman's correlation coefficient ranging from 0.28 to 0.33 for PD, and -0.55 to -0.50 (p-value <0.05) for PD variation, respectively. PD variation rate (PDVR) is the percentage change in the magnitude of constriction of PD on light stimulation. PDVR of >19.68% had a sensitivity of 86.96% (95% CI: 82.04 - 91.88%) and specificity of 64.97% (95% CI: 58.00 - 71.94%) to detect GCS>8. Conclusion: PD variation and PDVR measured by POCUS has significant correlation with GCS >8. The study showed good sensitivity and low specificity of PDVR on light stimulation to detect GCS >8.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".