Using Transorbital Sonography for Assessing Traumatic Brain Injury in Patients With Periorbital Hematoma

Objective: The aim of this study is to assess the comparative effectiveness of transorbital sonography (TOS) and the pupillary penlight visual assessment method in patients with traumatic brain injury (TBI) and periorbital hematoma.

Methods: A total of 140 patients with traumatic brain injury (TBI), meeting the inclusion and exclusion criteria, were selected from a tertiary hospital in Zhejiang Province between January 2022 and December 2023. Pupillary function in all patients was assessed using both TOS and the pupillary penlight visual assessment method on the first, third, and seventh day after admission. The stability and consistency of the measurement results were compared. Stability was determined using the coefficient of variation, whereas consistency was assessed using the intraclass correlation coefficient.

Results: The coefficients of variation for the pupillary transverse diameter values measured by TOS were 29.84% (left) and 29.55% (right) on day 1, 27.81% (left) and 26.88% (right) on day 3, and 26.80% (left) and 25.51% (right) on day 7. These values were consistently lower than those obtained through the pupillary penlight visual assessment method, indicating superior stability with the TOS measurement. In addition, the intraclass correlation coefficient analysis demonstrated consistency between the 2 methods, with values ranging from 0.562 to 0.809 (P<0.05), indicating good consistency.

Conclusion: TOS represents an innovative tool for neurological assessment. It has been validated that the presence or absence of eyelid edema does not compromise the accuracy of ultrasound-based pupillary function measurements. The 2 methods of measurement exhibit good consistency, with the TOS method demonstrating superior stability in monitoring data. This approach provides a more accurate means of assessing pupillary function in patients with TBI who have periorbital hematoma or facial swelling, particularly when opening the eyelid is challenging, thereby addressing a significant clinical nursing challenge.