PLoS ONE (Jan 2024)

Exploring the feasibility of pupillometry training and perceptions of potential use for intracranial pressure monitoring in Uganda: A mixed methods study.

  • Zoey Petitt,
  • Yesel Trillo Ordonez,
  • Chibueze Agwu,
  • Maura Ott,
  • Muhammad Shakir,
  • Alexandria Ayala Mullikin,
  • Jenna Davis,
  • Adham M Khalafallah,
  • Alan Tang,
  • Chidyaonga Shalita,
  • Joseph Mary Ssembatya,
  • Di D Deng,
  • Jennifer Headley,
  • Oscar Obiga,
  • Michael M Haglund,
  • Anthony T Fuller

DOI
https://doi.org/10.1371/journal.pone.0298619
Journal volume & issue
Vol. 19, no. 5
p. e0298619

Abstract

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IntroductionTraumatic brain injury (TBI) accounts for the majority of Uganda's neurosurgical disease burden; however, invasive intracranial pressure (ICP) monitoring is infrequently used. Noninvasive monitoring could change the care of patients in such a setting through quick detection of elevated ICP.PurposeGiven the novelty of pupillometry in Uganda, this mixed methods study assessed the feasibility of pupillometry for noninvasive ICP monitoring for patients with TBI.MethodsTwenty-two healthcare workers in Kampala, Uganda received education on pupillometry, practiced using the device on healthy volunteers, and completed interviews discussing pupillometry and its implementation. Interviews were assessed with qualitative analysis, while quantitative analysis evaluated learning time, measurement time, and accuracy of measurements by participants compared to a trainer's measurements.ResultsMost participants (79%) reported a positive perception of pupillometry. Participants described the value of pupillometry in the care of patients during examination, monitoring, and intervention delivery. Commonly discussed concerns included pupillometry's cost, understanding, and maintenance needs. Perceived implementation challenges included device availability and contraindications for use. Participants suggested offering continued education and engaging hospital leadership as implementation strategies. During training, the average learning time was 13.5 minutes (IQR 3.5), and the measurement time was 50.6 seconds (IQR 11.8). Paired t-tests to evaluate accuracy showed no statistically significant difference in comparison measurements.ConclusionPupillometry was considered acceptable for noninvasive ICP monitoring of patients with TBI, and pupillometer use was shown to be feasible during training. However, key concerns would need to be addressed during implementation to aid device utilization.