• DaiWai M Olson, Sonja Stutzman, Ciji Saju, Margaret Wilson, Weidan Zhao, and Venkatesh Aiyagari.
• Department of Neurology & Neurotherapeutics, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8855, USA. daiwai.olson@utsouthwestern.edu.
• Neurocrit Care. 2016 Apr 1; 24 (2): 251-7.

BackgroundSubjective scoring of pupil reactivity is a fundamental element of the neurological examination for which the pupillometer provides an objective measure.MethodsThis single-blinded observational study examined interrater reliability of pupil exam findings between two practitioners and between practitioners and a pupillometer.ResultsFrom 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.ConclusionsDespite 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.

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