{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:26:06Z","timestamp":1787959566626,"version":"build-2784847793"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>This study aimed to determine the validity of quantitative pupillometry to predict the length of time for return to full activity\/duty after a mild traumatic brain injury (mTBI) in a cohort of injured cadets at West Point.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Each subject received baseline (T0) quantitative pupillometry, in addition to evaluation with the Balance Error Scoring System (BESS), Standardized Assessment of Concussion (SAC), and Sport Concussion Assessment Tool 5th Edition Symptom Survey (SCAT5). Repeat assessments using the same parameters were conducted within 48 hours of injury (T1), at the beginning of progressive return to activity (T2), and at the completion of progressive return to activity protocols (T3). Pupillary metrics were compared on the basis of length of time to return to full play\/duty and the clinical scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The authors\u2019 statistical analyses found correlations between pupillometry measures at T1, including end-initial diameter and maximum constriction velocity, with larger change and faster constriction predicting earlier return to play. There was also an association with maximum constriction velocity at baseline (T0), predicting faster return to play.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The authors conclude that that pupillometry may be a valuable tool for assessing time to return to duty from mTBI by providing a measure of baseline resiliency to mTBI and\/or autonomic dysfunction in the acute phase after mTBI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.4.focus24140","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T14:52:11Z","timestamp":1720018331000},"page":"E12","source":"Crossref","is-referenced-by-count":5,"title":["Quantitative pupillometry as a biomarker for prediction of return to play in mild traumatic brain injury: a Military Traumatic Brain Injury Initiative study"],"prefix":"10.3171","volume":"57","author":[{"given":"Bradley A.","family":"Dengler","sequence":"first","affiliation":[{"name":"Military Traumatic Brain Injury Initiative (MTBI2), Bethesda, Maryland;"},{"name":"Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Meister","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Aderman","sequence":"additional","affiliation":[{"name":"John A. Feagin Sports Medicine Fellowship, Keller Army Community Hospital, United States Military Academy, West Point, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven R.","family":"Malvasi","sequence":"additional","affiliation":[{"name":"John A. Feagin Sports Medicine Fellowship, Keller Army Community Hospital, United States Military Academy, West Point, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy D.","family":"Ross","sequence":"additional","affiliation":[{"name":"John A. Feagin Sports Medicine Fellowship, Keller Army Community Hospital, United States Military Academy, West Point, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adele","family":"Fu","sequence":"additional","affiliation":[{"name":"Military Traumatic Brain Injury Initiative (MTBI2), Bethesda, Maryland;"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thaddeus","family":"Haight","sequence":"additional","affiliation":[{"name":"Military Traumatic Brain Injury Initiative (MTBI2), Bethesda, Maryland;"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor","family":"Bartanusz","sequence":"additional","affiliation":[{"name":"Military Traumatic Brain Injury Initiative (MTBI2), Bethesda, Maryland;"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason H.","family":"Boulter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackson","family":"Rudolph","sequence":"additional","affiliation":[{"name":"F. Edward Herbert School of Medicine, Uniformed Services University, Bethesda, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth L.","family":"Cameron","sequence":"additional","affiliation":[{"name":"John A. Feagin Sports Medicine Fellowship, Keller Army Community Hospital, United States Military Academy, West Point, New York;"},{"name":"Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"J Trauma Acute Care Surg","first-page":"220","article-title":"Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: implications for future military operations","volume":"93","author":"Dengler BA","year":"2022","unstructured":"Dengler BA, Agimi Y, Stout K,  Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: implications for future military operations. J Trauma Acute Care Surg. 2022;93(2):220\u2013228."},{"issue":"2","key":"b2","series-title":"J Neurotrauma","first-page":"210","article-title":"Military acute concussion evaluation: a report on clinical usability, utility, and user\u2019s perceived confidence","volume":"38","author":"Khokhar B","year":"2021","unstructured":"Khokhar B, Jorgensen-Wagers K, Marion D, Kiser S. Military acute concussion evaluation: a report on clinical usability, utility, and user\u2019s perceived confidence. J Neurotrauma. 2021;38(2):210\u2013217."},{"issue":"6","key":"b3","series-title":"Clin J Sport Med","first-page":"339","article-title":"Sport-related concussion: factors associated with prolonged return to play","volume":"14","author":"Asplund CA","year":"2004","unstructured":"Asplund CA, McKeag DB, Olsen CH. Sport-related concussion: factors associated with prolonged return to play. Clin J Sport Med. 2004;14(6):339\u2013343."},{"issue":"12","key":"b4","series-title":"Br J Sports Med","first-page":"941","article-title":"Predictors of clinical recovery from concussion: a systematic review","volume":"51","author":"Iverson GL","year":"2017","unstructured":"Iverson GL, Gardner AJ, Terry DP,  Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941\u2013948."},{"issue":"6","key":"b5","series-title":"Brain Inj","first-page":"840","article-title":"Association of acute vestibular\/ocular motor screening scores to prolonged recovery in collegiate athletes following sport-related concussion","volume":"34","author":"Whitney SL","year":"2020","unstructured":"Whitney SL, Eagle SR, Marchetti G, Mucha A, Collins MW, Kontos AP. Association of acute vestibular\/ocular motor screening scores to prolonged recovery in collegiate athletes following sport-related concussion. Brain Inj. 2020;34(6):840\u2013845."},{"key":"b6","series-title":"Front Neurol","first-page":"685313","article-title":"The expanding role of quantitative pupillometry in the evaluation and management of traumatic brain injury","volume":"12","author":"Boulter JH","year":"2021","unstructured":"Boulter JH, Shields MM, Meister MR, Murtha G, Curry BP, Dengler BA. The expanding role of quantitative pupillometry in the evaluation and management of traumatic brain injury. Front Neurol. 2021;12:685313."},{"issue":"11","key":"b7","series-title":"JAMA Ophthalmol","first-page":"1135","article-title":"Utility of pupillary light reflex metrics as a physiologic biomarker for adolescent sport-related concussion","volume":"138","author":"Master CL","year":"2020","unstructured":"Master CL, Podolak OE, Ciuffreda KJ,  Utility of pupillary light reflex metrics as a physiologic biomarker for adolescent sport-related concussion. JAMA Ophthalmol. 2020;138(11):1135\u20131141."},{"key":"b8","series-title":"Mil Med","first-page":"usad271","article-title":"Normative values for pupillary light reflex metrics among healthy service academy cadets","author":"Aderman MJ","year":"2023","unstructured":"Aderman MJ, Meister MR, Roach MH,  Normative values for pupillary light reflex metrics among healthy service academy cadets. Mil Med. 2023;usad271."},{"issue":"4","key":"b9","series-title":"Brain Inj","first-page":"295","article-title":"Symptom resolution following a repeat concussion within the same athlete","volume":"38","author":"Tang AR","year":"2024","unstructured":"Tang AR, Williams KL, Davis PJ,  Symptom resolution following a repeat concussion within the same athlete. Brain Inj. 2024;38(4):295\u2013303."},{"issue":"1","key":"b10","series-title":"BMC Anesthesiol","first-page":"274","article-title":"Pupil maximum constriction velocity predicts post-induction hypotension in patients with lower ASA status: a prospective observational study","volume":"22","author":"Shao L","year":"2022","unstructured":"Shao L, Zhou Y, Yue Z,  Pupil maximum constriction velocity predicts post-induction hypotension in patients with lower ASA status: a prospective observational study. BMC Anesthesiol. 2022;22(1):274."},{"issue":"1","key":"b11","series-title":"J Clin Med","first-page":"161","article-title":"Predictive value of subacute heart rate variability for determining outcome following adolescent concussion","volume":"10","author":"Coffman CA","year":"2021","unstructured":"Coffman CA, Kay JJM, Saba KM,  Predictive value of subacute heart rate variability for determining outcome following adolescent concussion. 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Clin J Sport Med. 2012;22(2):98\u2013104."},{"issue":"1","key":"b14","series-title":"Clin J Sport Med","first-page":"15","article-title":"Preinjury and postinjury factors that predict sports-related concussion and clinical recovery time","volume":"31","author":"Putukian M","year":"2021","unstructured":"Putukian M, Riegler K, Amalfe S, Bruce J, Echemendia R. Preinjury and postinjury factors that predict sports-related concussion and clinical recovery time. Clin J Sport Med. 2021;31(1):15\u201322."},{"issue":"4","key":"b15","series-title":"Am J Sports Med","first-page":"1106","article-title":"Utility of VOMS, SCAT3, and ImPACT baseline evaluations for acute concussion identification in collegiate athletes: findings from the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium","volume":"50","author":"Ferris LM","year":"2022","unstructured":"Ferris LM, Kontos AP, Eagle SR,  Utility of VOMS, SCAT3, and ImPACT baseline evaluations for acute concussion identification in collegiate athletes: findings from the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium. Am J Sports Med. 2022;50(4):1106\u20131119."},{"issue":"3","key":"b16","series-title":"Br J Sports Med","first-page":"144","article-title":"Diagnostic accuracy and reliability of sideline concussion evaluation: a prospective, case-controlled study in college athletes comparing newer tools and established tests","volume":"56","author":"Harmon KG","year":"2022","unstructured":"Harmon KG, Whelan BM, Aukerman DF,  Diagnostic accuracy and reliability of sideline concussion evaluation: a prospective, case-controlled study in college athletes comparing newer tools and established tests. Br J Sports Med. 2022;56(3):144\u2013150."},{"issue":"1","key":"b17","series-title":"PM R","first-page":"50","article-title":"Intrarater and interrater reliability of the Balance Error Scoring System (BESS)","volume":"1","author":"Finnoff JT","year":"2009","unstructured":"Finnoff JT, Peterson VJ, Hollman JH, Smith J. Intrarater and interrater reliability of the Balance Error Scoring System (BESS). PM R. 2009;1(1):50\u201354."},{"issue":"2","key":"b1","series-title":"J Trauma Acute Care Surg","first-page":"220","article-title":"Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: implications for future military operations","volume":"93","author":"Dengler BA","year":"2022","unstructured":"Dengler BA, Agimi Y, Stout K,  Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: implications for future military operations. J Trauma Acute Care Surg. 2022;93(2):220\u2013228."},{"issue":"2","key":"b2","series-title":"J Neurotrauma","first-page":"210","article-title":"Military acute concussion evaluation: a report on clinical usability, utility, and user\u2019s perceived confidence","volume":"38","author":"Khokhar B","year":"2021","unstructured":"Khokhar B, Jorgensen-Wagers K, Marion D, Kiser S. Military acute concussion evaluation: a report on clinical usability, utility, and user\u2019s perceived confidence. J Neurotrauma. 2021;38(2):210\u2013217."},{"issue":"6","key":"b3","series-title":"Clin J Sport Med","first-page":"339","article-title":"Sport-related concussion: factors associated with prolonged return to play","volume":"14","author":"Asplund CA","year":"2004","unstructured":"Asplund CA, McKeag DB, Olsen CH. Sport-related concussion: factors associated with prolonged return to play. Clin J Sport Med. 2004;14(6):339\u2013343."},{"issue":"12","key":"b4","series-title":"Br J Sports Med","first-page":"941","article-title":"Predictors of clinical recovery from concussion: a systematic review","volume":"51","author":"Iverson GL","year":"2017","unstructured":"Iverson GL, Gardner AJ, Terry DP,  Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941\u2013948."},{"issue":"6","key":"b5","series-title":"Brain Inj","first-page":"840","article-title":"Association of acute vestibular\/ocular motor screening scores to prolonged recovery in collegiate athletes following sport-related concussion","volume":"34","author":"Whitney SL","year":"2020","unstructured":"Whitney SL, Eagle SR, Marchetti G, Mucha A, Collins MW, Kontos AP. Association of acute vestibular\/ocular motor screening scores to prolonged recovery in collegiate athletes following sport-related concussion. Brain Inj. 2020;34(6):840\u2013845."},{"key":"b6","series-title":"Front Neurol","first-page":"685313","article-title":"The expanding role of quantitative pupillometry in the evaluation and management of traumatic brain injury","volume":"12","author":"Boulter JH","year":"2021","unstructured":"Boulter JH, Shields MM, Meister MR, Murtha G, Curry BP, Dengler BA. The expanding role of quantitative pupillometry in the evaluation and management of traumatic brain injury. Front Neurol. 2021;12:685313."},{"issue":"11","key":"b7","series-title":"JAMA Ophthalmol","first-page":"1135","article-title":"Utility of pupillary light reflex metrics as a physiologic biomarker for adolescent sport-related concussion","volume":"138","author":"Master CL","year":"2020","unstructured":"Master CL, Podolak OE, Ciuffreda KJ,  Utility of pupillary light reflex metrics as a physiologic biomarker for adolescent sport-related concussion. JAMA Ophthalmol. 2020;138(11):1135\u20131141."},{"key":"b8","series-title":"Mil Med","first-page":"usad271","article-title":"Normative values for pupillary light reflex metrics among healthy service academy cadets","author":"Aderman MJ","year":"2023","unstructured":"Aderman MJ, Meister MR, Roach MH,  Normative values for pupillary light reflex metrics among healthy service academy cadets. Mil Med. 2023;usad271."},{"issue":"4","key":"b9","series-title":"Brain Inj","first-page":"295","article-title":"Symptom resolution following a repeat concussion within the same athlete","volume":"38","author":"Tang AR","year":"2024","unstructured":"Tang AR, Williams KL, Davis PJ,  Symptom resolution following a repeat concussion within the same athlete. Brain Inj. 2024;38(4):295\u2013303."},{"issue":"1","key":"b10","series-title":"BMC Anesthesiol","first-page":"274","article-title":"Pupil maximum constriction velocity predicts post-induction hypotension in patients with lower ASA status: a prospective observational study","volume":"22","author":"Shao L","year":"2022","unstructured":"Shao L, Zhou Y, Yue Z,  Pupil maximum constriction velocity predicts post-induction hypotension in patients with lower ASA status: a prospective observational study. BMC Anesthesiol. 2022;22(1):274."},{"issue":"1","key":"b11","series-title":"J Clin Med","first-page":"161","article-title":"Predictive value of subacute heart rate variability for determining outcome following adolescent concussion","volume":"10","author":"Coffman CA","year":"2021","unstructured":"Coffman CA, Kay JJM, Saba KM,  Predictive value of subacute heart rate variability for determining outcome following adolescent concussion. J Clin Med. 2021;10(1):161."},{"issue":"2","key":"b12","series-title":"Brain Inj","first-page":"247","article-title":"Parasympathetic baroreflexes and heart rate variability during acute stage of sport concussion recovery","volume":"31","author":"Bishop S","year":"2017","unstructured":"Bishop S, Dech R, Baker T, Butz M, Aravinthan K, Neary JP. Parasympathetic baroreflexes and heart rate variability during acute stage of sport concussion recovery. Brain Inj. 2017;31(2):247\u2013259."},{"issue":"2","key":"b13","series-title":"Clin J Sport Med","first-page":"98","article-title":"Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms","volume":"22","author":"Covassin T","year":"2012","unstructured":"Covassin T, Elbin RJI III, Larson E, Kontos AP. Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms. Clin J Sport Med. 2012;22(2):98\u2013104."},{"issue":"1","key":"b14","series-title":"Clin J Sport Med","first-page":"15","article-title":"Preinjury and postinjury factors that predict sports-related concussion and clinical recovery time","volume":"31","author":"Putukian M","year":"2021","unstructured":"Putukian M, Riegler K, Amalfe S, Bruce J, Echemendia R. Preinjury and postinjury factors that predict sports-related concussion and clinical recovery time. Clin J Sport Med. 2021;31(1):15\u201322."},{"issue":"4","key":"b15","series-title":"Am J Sports Med","first-page":"1106","article-title":"Utility of VOMS, SCAT3, and ImPACT baseline evaluations for acute concussion identification in collegiate athletes: findings from the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium","volume":"50","author":"Ferris LM","year":"2022","unstructured":"Ferris LM, Kontos AP, Eagle SR,  Utility of VOMS, SCAT3, and ImPACT baseline evaluations for acute concussion identification in collegiate athletes: findings from the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium. Am J Sports Med. 2022;50(4):1106\u20131119."},{"issue":"3","key":"b16","series-title":"Br J Sports Med","first-page":"144","article-title":"Diagnostic accuracy and reliability of sideline concussion evaluation: a prospective, case-controlled study in college athletes comparing newer tools and established tests","volume":"56","author":"Harmon KG","year":"2022","unstructured":"Harmon KG, Whelan BM, Aukerman DF,  Diagnostic accuracy and reliability of sideline concussion evaluation: a prospective, case-controlled study in college athletes comparing newer tools and established tests. Br J Sports Med. 2022;56(3):144\u2013150."},{"issue":"1","key":"b17","series-title":"PM R","first-page":"50","article-title":"Intrarater and interrater reliability of the Balance Error Scoring System (BESS)","volume":"1","author":"Finnoff JT","year":"2009","unstructured":"Finnoff JT, Peterson VJ, Hollman JH, Smith J. Intrarater and interrater reliability of the Balance Error Scoring System (BESS). 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