Comparison Between Pupillometry and the Numerical Rating Scale

Comparison Between Pupillometry and the Numerical Rating Scale for the Assessment of Pain in Communicating Adult Patients Presenting to the Emergency Room.

Given the difficulties encountered with subjective pain assessment tools, one of the ideas for reducing the occurrence of insufficient analgesia administration in the emergency department is to find a tool capable of measuring pain without requiring the patient's participation, and which could be integrated into the systematic measurement of the 4 other vitals. An interesting idea is the measurement of pupillary diameter and its reflex variations by a portable pupillometer. Indeed, the diameter of the pupil (DP) reflects the constant interactions between the sympathetic and parasympathetic systems at the level of the iris muscles. Pupillometry measures the change in pupillary diameter and allows the performance of three dynamic tests useful in the assessment of pain.

Inclusion Criteria:

• All patients presenting to the emergency room, aged 18 years or over, able to communicate, with hemodynamic and respiratory stability, are eligible.

Exclusion Criteria:

• - Refusal to participate in the study; refusal to sign informed consent.
• Consent impossible to obtain (cognitive disorders, language barrier…).
• Patient taking immediate-release opioid medication (last dose within the last 12 hours).
• Patient taking prolonged-release opioid medication (last dose within the last 24 hours).
• Basic treatment with a dopaminergic D2 antagonist (antipsychotic drugs).
• Basic treatment with dopamine antagonist antiemetic medication (metoclopramide (T1/2 5-6h), domperidone (T1/2 7-9h), alizapride (T1/2 3h)) within the last 12 hours.
• Patient taking clonidine (last dose within the last 24 hours).
• Use of topical ocular drugs modifying pupillary parameters in the last 24 hours.
• Bilateral eye surgery modifying the possibilities of variation in pupillary diameter bilaterally.
• Parkinson's or Alzheimer's disease at a dysautonomic stage.
• Admission to the emergency room for acute ocular pathology.
• History of diabetes at a dysautonomic stage.
• History of alcoholism at a dysautonomic stage.
• History of glaucoma.
• Pregnant patient with preeclampsia.