Rapid Military Triage of Traumatic Brain Injury Using Eye Tracking and Pupillometry

Abstract

Rapid triage in military operations must reliably identify “hidden” neurological impairment among soldiers who appear only slightly wounded. Mild to moderate traumatic brain injury (TBI), concussion, and neurotoxic exposures can present with subtle early signs that are easily missed under stress, time pressure, and resource constraints. Eye tracking and pupillometry are promising for early triage because they probe brainstem and oculomotor function, can be captured quickly with deployable devices, and provide quantitative, repeatable measures suitable for decision support. This paper proposes a research program to develop an eye tracking–based, explainable rule base with operational thresholds to support early military triage. The goal is a field-ready decision logic that estimates the likelihood of clinically relevant impairment (e.g., concussion/moderate TBI, severe TBI warning signs, or neurotoxic syndromes) in “walking wounded” soldiers and outputs a transparent triage recommendation (e.g., high / medium / low risk), aligned with medic workflows. Methodology. We will implement a rapid assessment protocol combining (1) pupillary light reflex metrics, (2) basic oculomotor screening (e.g., gaze stability, smooth pursuit, saccadic control), and (3) short mobile cognitive-oculomotor tasks that can be completed in minutes. Candidate rules will be derived from a structured synthesis of prior clinical and applied evidence and formalized into interpretable “if–then” statements with thresholds and confidence flags. The rule base will be designed with explicit handling of confounds relevant to deployment (illumination variability, fatigue, stress, motion, and partial occlusion), including quality checks and fallback logic when signals are unreliable. Expected results. The project will deliver (i) a prototype triage tool integrating eye tracking data capture and automated rule evaluation, (ii) an initial threshold library for the most informative pupil and oculomotor features, and (iii) a validation plan and performance targets emphasizing sensitivity to clinically relevant TBI risk while maintaining practical specificity for operational use. We will prioritize explainability (rules that medics can interpret) and actionability (clear next steps such as observation, repeat testing, or expedited evacuation).Future work will include controlled studies for normative baselines, simulated field trials, and prospective evaluations in training environments, with iterative refinement toward robust deployment and integration with other physiological measures where beneficial.

Keywords: Military triage, traumatic brain injury, eye tracking, rule basis, rapid detection

DOI: 10.54941/ahfe1008068