title: Interrater Reliability of Pupillary Assessments.
abstract: BACKGROUND
  Subjective scoring of pupil reactivity is a fundamental element of the neurological examination for which the pupillometer provides an objective measure.
  
  
  METHODS
  This single-blinded observational study examined interrater reliability of pupil exam findings between two practitioners and between practitioners and a pupillometer.
  
  
  RESULTS
  From 2329 paired assessments, the interrater reliability between practitioners was only moderate for pupil size (k = 0.54), shape (k = 0.62), and reactivity (k = 0.40). Only 33.3% of pupils scored as non-reactive by practitioners were scored as non-reactive by pupillometry.
  
  
  CONCLUSIONS
  Despite the strong emphasis placed on the traditional pupil examination, especially for patients with a neurological illness, there is limited interrater reliability for subjective scoring of pupillary assessments. Thus, the use of automated pupillometers should be examined as a potential method to increase the reliability of measuring of pupil reactivity.
authors.affiliation: Department of Neurology & Neurotherapeutics, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8855, USA. daiwai.olson@utsouthwestern.edu.
authors.forename: DaiWai M
authors.initials: DM
authors.lastname: Olson
authors.affiliation: Department of Neurology & Neurotherapeutics, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8855, USA.
authors.forename: Sonja
authors.initials: S
authors.lastname: Stutzman
authors.affiliation: Department of Neurology & Neurotherapeutics, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8855, USA.
authors.forename: Ciji
authors.initials: C
authors.lastname: Saju
authors.affiliation: Department of Neurology & Neurotherapeutics, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8855, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Wilson
authors.affiliation: Department of Neurology & Neurotherapeutics, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8855, USA.
authors.forename: Weidan
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Department of Neurology & Neurotherapeutics, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8855, USA.|Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Aiyagari
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000592:standards*; D011680:Pupil / Q000502:physiology*; D012025:Reflex, Pupillary / Q000502:physiology*; D015203:Reproducibility of Results; D016037:Single-Blind Method
keywords: Interrater reliability; Neurological illness; Pupil assessment; Pupillometry; Traumatic brain injury