# COVERT– COvert Volitional Eye Response Test

> **NIH NIH R21** · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · 2022 · $231,708

## Abstract

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.

## Key facts

- **NIH application ID:** 10507251
- **Project number:** 1R21NS128326-01
- **Recipient organization:** UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
- **Principal Investigator:** Ayham Alkhachroum
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $231,708
- **Award type:** 1
- **Project period:** 2022-09-21 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10507251

## Citation

> US National Institutes of Health, RePORTER application 10507251, COVERT– COvert Volitional Eye Response Test (1R21NS128326-01). Retrieved via AI Analytics 2026-06-01 from https://api.ai-analytics.org/grant/nih/10507251. Licensed CC0.

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