COVERT– COvert Volitional Eye Response Test

COVERT™ COvert 意志眼反应测试

基本信息

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
项目类别：
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

项目摘要

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.

项目概要急性脑损伤 (ABI) 的死亡率很高，主要原因是早期停止维持生命的治疗住院期间。这一关键决定受到脑部手术后患者是否仍然无反应的影响。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，眼动追踪评估依赖于检查者，并且可能会错误分类多达 40% 的无反应且保留意识的患者，或者隐蔽跟踪。眼动追踪技术的最新发展提供了足够的时间和空间保真度对患者跟踪视觉刺激的能力进行知情评估。定量评估受伤后不久，重症监护病房（ICU）中尚未研究对不同视觉刺激的眼球追踪，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依据在 ICU 中使用眼动仪眼镜作为生物标记来检测术后隐蔽跟踪的前提和可行性 ABI。我们假设在 ICU 住院期间使用眼动眼镜进行眼动追踪检测可能会有所帮助作为一种生物标志物，用于识别无反应但可能有更好预后的患者的秘密追踪。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）。我们将使用 3 分钟的时间评估两个机构的 50 名无反应 ABI 患者眼球追踪实验通过眼球追踪器来镜像、移动条纹和明亮的彩色物体。这实验将在受伤后第 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临床评估进行追踪。我们还将获得一个第 7 天进行脑电图评估丘脑皮质完整性并与隐蔽状态相关联追踪。使用 COVERT 测试，我们计划使用眼睛识别无反应 ABI 患者的秘密跟踪追踪眼镜（目标 1）。我们还将利用格拉斯哥成果探索秘密追踪是否可以预测康复情况 ABI 后 3 个月随访时的规模扩展（目标 2）。这项研究的结果有可能改变目前在严重 ABI 后的临床实践中使用一种新颖的定量方法进行预测范式眼球追踪技术可以评估对视觉刺激的追踪，以识别隐蔽追踪。