COVERT– COvert Volitional Eye Response Test

COVERT™ COvert 意志眼反应测试

• 批准号: 10507251
• 负责人: Ayham Alkhachroum
• 金额: $ 23.17万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-21 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10507251
• 关键词: Acute Brain Injuries; Awareness; Biological Markers; Brain Injuries; Brain Stem; Caring; Cell Nucleus; Cerebral cortex; Cessation of life; Clinical; Clinical assessments; Color; Coma; Conscious; Consciousness Disorders; Data; Data Analyses; Detection; Electroencephalogram; Electrophysiology (science); Eye; Eye Development; Eye Movements; Family; Family member; Future; Glasgow Outcome Scale; Goals; Hospitalization; Injury; Institution; Intensive Care Units; Knowledge; Midbrain structure; Patients; Pattern; Physical Examination; Predictive Value; Prognosis; Prospective Studies; Recovery; Societies; Stimulus; Surveys; Techniques; Technology; Testing; Uncertainty; United States National Institutes of Health; Volition; Withdrawal; clinical examination; clinical practice; cognitive function; experimental study; follow-up; improved; life-sustaining therapy; loved ones; mortality; neuroregulation; novel; novel strategies; preservation; prognostic value; prognostication; response; severe injury; visual stimulus; visual tracking

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.

项目摘要 急性脑损伤（ABI）具有很高的死亡率，主要是由生命维持疗法提早撤离的驱动 住院期间。这个关键决定受到大脑后患者是否无响应的影响 受伤。观察到不同视觉刺激的眼动追踪是临床检查的重要组成部分 意识状态和意识恢复的潜力。但是，眼睛跟踪评估是 检查员依赖，并且可能会误导多达40％的无响应性患者，或者 秘密跟踪。眼睛跟踪技术的最新发展提供了足够的时间和空间 忠诚度以对患者追踪视觉刺激的能力进行明智的评估。定量评估 受伤后不久，在重症监护室（ICU）中尚未研究针对不同视觉刺激的目光跟踪， 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 前提和在ICU中使用眼球眼镜作为生物标志物的可行性，以检测秘密跟踪 阿比。我们假设使用眼镜眼镜检测眼睛跟踪，在ICU停留期间可能会使用 作为一个生物标志物，可以识别出反应迟钝但预后更好的患者的秘密跟踪。 在这项研究中，我们建议使用秘密测试严重脑损伤后不久使用一种新方法（秘密 意志眼反应测试）。我们将使用3分钟的两个机构在两个机构中评估50名无反应性ABI患者 眼睛跟踪实验，以镜像，移动条纹和鲜艳的物体通过眼线跟踪器。这 在受伤后第3、7、10和14天，每天将进行两次实验。临床团队将进行调查 是否基于患者的临床评估跟踪。我们还将获得 第7天的脑电图评估丘脑皮质完整性并与秘密状态相关 追踪。使用秘密测试，我们计划使用眼睛来识别无反应性ABI患者的秘密跟踪 跟踪器眼镜（AIM 1）。我们还将使用格拉斯哥结果探索秘密跟踪是否可以预测恢复 在ABI之后的3个月随访（AIM 2）时，比例扩展了。这项研究的结果有可能改变 严重ABI之后，使用一种新型的定量方法，使用了一种新的定量方法 可以评估对视觉刺激的跟踪以识别秘密跟踪的目光跟踪技术。