Interrater Reliability of Pupillary Assessments

DaiWai M. Olson, Sonja Stutzman, Ciji Saju, Margaret Wilson, Weidan Zhao, Venkatesh Aiyagari

Research output: Contribution to journalArticlepeer-review

106 Scopus citations


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.

Original languageEnglish (US)
JournalNeurocritical Care
StateAccepted/In press - Sep 17 2015


  • Interrater reliability
  • Neurological illness
  • Pupil assessment
  • Pupillometry
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine


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