COVERT– COvert Volitional Eye Response Test

项目摘要 急性脑损伤（ABI）的死亡率很高，主要是由于早期停止维持生命的治疗 在住院期间。这一关键决定受到患者在脑损伤后是否仍无反应的影响。 损伤观察不同视觉刺激的眼动轨迹是临床检查的重要组成部分， 意识状态和恢复意识的潜力。然而，眼动追踪评估 依赖于检查者，并且可以错误分类高达40%的无反应患者， 秘密追踪眼动跟踪技术的最新发展提供了足够的时间和空间 忠实性，对患者跟踪视觉刺激的能力进行知情评估。定量评估 在重症监护室（ICU）中，在受伤后不久， 当临床医生与家人讨论病人的护理目标时。我们的初步数据提供了 在ICU中使用眼动追踪眼镜作为生物标志物来检测隐蔽追踪的前提和可行性。 ABI.我们假设，在ICU住院期间，使用眼动仪眼镜检测眼动跟踪可能有助于 作为一种生物标志物，以识别无反应但预后可能更好的患者的隐蔽跟踪。 在这项研究中，我们建议在严重脑损伤后不久使用COVERT测试（COvert 意志眼反应测试）。我们将在两个机构评估50名无反应的ABI患者， 眼动追踪实验，通过眼动追踪器对镜像、移动条纹和明亮的彩色物体进行跟踪。的 实验将在损伤后第3、7、10和14天每天进行两次。临床团队将接受调查， 患者是否根据其临床评估进行跟踪。我们还将获得 在第7天进行脑电图，以评估丘脑皮质完整性并与内隐状态相关 跟踪.使用COVERT测试，我们计划使用眼睛识别无反应ABI患者的隐蔽跟踪- 跟踪眼镜（目标1）。我们还将探讨是否隐蔽跟踪可以预测恢复，使用格拉斯哥结果 ABI后3个月随访时扩展量表（目标2）。这项研究的结果有可能改变 严重ABI后临床实践中的当前统计范式，使用一种新的定量方法， 眼动追踪技术可以评估对视觉刺激的跟踪，以识别隐蔽跟踪。

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.