COVERT– COvert Volitional Eye Response Test

项目摘要 急性脑损伤(ABI)死亡率很高，很大程度上是由于早期停止维持生命的治疗。 在住院期间。这一关键决定受患者脑损伤后是否仍无反应的影响。 受伤。观察眼睛对不同视觉刺激的跟踪是临床检查的重要组成部分，以确定 意识状态和意识恢复的潜力。然而，眼球跟踪评估是 依赖于检查员，并可能错误地对意识保留的无反应患者进行高达40%的分类，或者 秘密追踪。眼球跟踪技术的最新发展提供了足够的时间和空间 对患者跟踪视觉刺激的能力做出知情的评估。量化评估 在重症监护病房(ICU)中，对不同视觉刺激的眼睛跟踪尚未被研究，在损伤后不久， 当临床医生与家人讨论患者的护理目标时。我们的初步数据提供了科学的 ICU使用眼球跟踪眼镜作为生物标志物检测隐蔽追踪的前提和可行性 艾比。我们推测，在ICU期间使用眼球跟踪器眼镜检测眼睛跟踪可能会起到作用 作为一种生物标志物，用于识别无反应但预后较好的患者的秘密跟踪。 在这项研究中，我们建议使用一种新的方法，在严重脑损伤后不久使用隐蔽测试(COMERT 意志性眼球反应测试)。我们将评估两个机构的50名无反应的ABI患者，使用3分钟的 眼睛跟踪实验，通过眼睛跟踪器来镜像、移动条纹和色彩鲜艳的物体。这个 实验将在伤后第3、7、10、14天每天进行两次。临床团队将在 患者是否根据他们的临床评估进行跟踪。我们还将获得一个 第7天脑电检查评估丘脑皮质完整性及其与隐匿状态的关系 追踪。通过使用秘密测试，我们计划使用眼睛来识别无反应的ABI患者的秘密跟踪- 跟踪眼镜(目标1)。我们还将使用格拉斯哥的结果来探索秘密跟踪是否可以预测康复 量表-在ABI后3个月的随访中扩展(目标2)。这项研究的结果有可能改变 使用一种新的定量方法在临床实践中使用新的定量方法预测严重脑损伤后的当前预测范例 眼睛跟踪器技术，可以评估对视觉刺激的跟踪，以识别隐藏的跟踪。

Project Summary Acute brain injury (ABI) has a high mortality, largely driven by the early withdrawal of life-sustaining therapies during hospitalization. This critical decision is influenced by whether patients remain unresponsive after brain injury. Observing eye tracking to different visual stimuli is an important part of clinical examination to determine the conscious state and the potential for recovery of consciousness. However, eye tracking assessments are examiner dependent, and can misclassify up to 40% of unresponsive patients with preserved awareness, or covert tracking. The recent development of eye tracking technology provides sufficient temporal and spatial fidelity to make an informed assessment on patients' ability to track visual stimuli. Quantitative assessments of eye tracking to different visual stimuli have not been studied in the intensive care unit (ICU), shortly after injury, when clinicians discuss the patients' goals of care with families. Our preliminary data provide the scientific premise and the feasibility of using eye-tracker glasses in the ICU as a biomarker to detect covert tracking after ABI. We hypothesize that the detection of eye tracking using eye-tracker glasses, during the ICU stay may serve as a biomarker to identify covert tracking in patients who are unresponsive but who may have a better prognosis. In this study, we propose using a novel approach shortly after severe brain injury using the COVERT test (COvert Volitional Eye Response Test). We will assess 50 unresponsive ABI patients at two institutions using a 3-minute eye tracking experiment to mirror, moving stripes, and a bright colored object via the eye-trackers. The experiment will be done twice a day on days 3, 7, 10, and 14 post injury. The clinical team will be surveyed on whether the patient is tracking or not based on their clinical assessment. We will also obtain an electroencephalogram on day 7 to evaluate the thalamocortical integrity and correlate with the state of covert tracking. Using the COVERT test, we plan to identify covert tracking in unresponsive ABI patients using the eye- tracker glasses (Aim 1). We will also explore if covert tracking can predict recovery, using Glasgow Outcome Scale-Extended at 3-month follow-up after ABI (Aim 2). Results from this study have the potential to change the current prognostication paradigms in clinical practice after severe ABI using a novel quantitative approach using the eye-tracker technology that can assess tracking to visual stimuli to identify covert tracking.