Pediatric Brain Death: Experience of a Single Center

Gençpınar, Pınar; Dursun, Oğuz; Tekgüç, Hakan; Ünal, Ali; Haspolat, Şenay; Duman, Özgür

doi:10.5336/medsci.2014-41309

Cited by 3 publications

(7 citation statements)

References 39 publications

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“…DI is an expected outcome in patients with brain death [17], and various studies have reported DI rates varying between 35-75 percent [11,14]. Similarly, the rate of DI was found to be 45 percent in the present study.…”

Section: Discussionsupporting

confidence: 79%

“…In literature, the M/F ratio was found to be comparable in patients with confirmed brain death and age range was between 1-17 years [8,11]. In two different studies, the mean age was 7 and 7.8 years [12,13], while in the present study, the age range was 1-17 years and the mean age was 8.47±5.73 years.…”

Section: Discussionsupporting

confidence: 51%

“…In several studies, trauma has been reported as the most common cause of brain death, and the rates are similar in Turkey [1]. In a study by Gençpınar et al [11], the rate of trauma-related brain death was reported as 47 percent, while Gündüz et al [14] reported trauma-related brain death in 55 percent of the patients included in their study. In the present study, trauma-related brain death occurred in 15 percent (n=3) of the patients, with the most common cause of brain death being fulminant hepatitis, observed in 35 percent (n=7) of the patients.…”

Section: Discussionmentioning

confidence: 96%

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Evaluation of Brain Death in Children: A Single Center Experience

et al. 2019

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Introduction: Brain death is defined as a status of apnea, coma and the absence of brainstem reflexes, in addition to the presence of electrocerebral silence (ECS) on an electroencephalography (EEG). Trauma and anoxic encephalopathy are the most common causes of brain death in children, with incidences of brain death reported to vary between 0.65-1.2 percent. A diagnosis of brain death can be made based on a detailed anamnesis, physical examination findings and supportive test results. When pediatric patients are being evaluated by EEG, they should also be assessed in terms of medications, metabolic encephalopathy, hypothermia, electrolyte imbalance and acid-base imbalance. Patients and Methods:The present study included patients who suffered brain death during hospitalization in the pediatric intensive care unit of Inonu University Turgut Ozal Medical Center between 2010 and 2017. The medical files of the patients were reviewed retrospectively. All patients included in the study underwent an EEG and an apnea test was performed on all patients. The cerebral blood flow (CBF) measurement was obtained through a Computerized Tomography Angiography (CTA), and all patients underwent a Magnetic Resonance Angiography (MRA) and a Transcranial Doppler Ultrasonography (TCD). Results:Of the 20 patients included in the study, nine (45%) were female and 11 (55%) were male, with a mean age of 8.47±5.73 years. Of the total, seven patients presented with fulminant hepatitis, three with trauma, three with sepsis, two with drowning, two with cerebrovaskuler disease (CVD), and one patient each with lymphoma, suicide and electric shock. The families of only two (10%) patients donated the organs of the deceased. Of the 20 patients, four were Syrian, and of which were being monitored with the diagnosis of liver failure. An apnea test was positive in all patients, and in all patients, the EEG findings supported brain death. Imaging methods were carried out to demonstrate the absence of CBF flow in 11 (55%) patients, and diabetes insipidus (DI) developed in nine (45%) of the patients with brain death. Conclusion:In conclusion, a multidisciplinary approach is required for the diagnosis of brain death. An evaluation of laboratory findings and EEG results together with the findings of a physical examination is important, particularly in centers like our clinics where more than 50 pediatric transplantations are carried out each year. The development of hypernatremia in patients with DI is now an important parameter in the loss of brain function. Keywords: Brain death, Childhood, EEG Aslan et al. / Brain Death in Children 510 ORTADOGU TIP DERG 2019; 11(4): 509-516 ÖZ Giriş ve Amaç: Beyin ölümü apne, koma ve beyin sapı reflekslerinin bulunmamasına ek olarak elektroserebral sessiz elektroensefalografi (EEG) bulunması durumudur. Çocuklarda beyin ölümü en sık travma ve anoksik ensefalopati sonucu ortaya çıkar. Beyin ölümü insidansının %0,65 ila %1,2 arasında değiştiğini bildirmiştir. Beyin ölümü tanısı iyi bir anamnez, fizik muayene ve yardımcı t...

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 96%

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Evaluation of Brain Death in Children: A Single Center Experience

et al. 2019

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“…One study conducted by Gencpınar and her colleagues confirmed the pediatric organ donor rate in 2015 as 46%, while Yalındağ Öztürk et al [40] reported the rate of brain death as 1.1% and organ donor rate as 20%. [39] In this study, we diagnosed TBI-related brain death in six children (6.8%), of whom five became organ donors following family declarations. Although TBI-related brain death is only a small fraction of brain death etiology, recognizing the increase in donor trend at our center compared to previous years is inevitable.…”

Section: Discussionmentioning

confidence: 93%

“…Although TBI-related brain death is only a small fraction of brain death etiology, recognizing the increase in donor trend at our center compared to previous years is inevitable. [39] Positive physician-family communication and raising public awareness towards organ donation undeniably play an important role in the escalating trend. [41] Our study has some limitations: (i) retrospective nature of this study because of risks of potential bias, not allowing definite interpretations; (ii) a limited number of patients included owing to inclusion criteria for those admitted to PICU in 2-year period; (iii) evaluation of long-term cognitive functions on the study population was not possible; (iv) uncertainty about the time elapsed from the moment of trauma incident to PICU admission, which was quoted to be the most critical hours.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Mortality in Pediatric Traumatic Brain Injury: Implementations from a Tertiary Pediatric Intensive Care Facility

Ongun

Dursun²

2017

Ulus Travma Acil Cerrahi Derg

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Mortality rate was 12.5%; six patients progressed to brain death with organ donor approvals in five. Initial hypotension, lung contusion, injury severity scores and Rotterdam-CT scores were related with mortality. Rotterdam-CT score was determined as the independent risk factor for mortality; one increment in the score increased the odd of recovery by 20.334 times (%95 CI 1.999-206.879). ISS score was also borderline significant (p=0.052; OR:1.195 %95 CI 0.999-1.430).

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Ancillary investigations for death determination in infants and children: a systematic review and meta-analysis

McKinnon

Maratta

Zuckier

et al. 2023

Can J Anesth/J Can Anesth

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Purpose We performed a systematic review and meta-analysis to determine the diagnostic test accuracy of ancillary investigations for declaration of death by neurologic criteria (DNC) in infants and children. Source We searched MEDLINE, EMBASE, Web of Science, and Cochrane databases from their inception to June 2021 for relevant randomized controlled trials, observational studies, and abstracts published in the last three years. We identified relevant studies using Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology and a two-stage review. We assessed the risk of bias using the QUADAS-2 tool, and applied Grading of Recommendations Assessment, Development, and Evaluation methodology to determine the certainty of evidence. A fixed-effects model was used to meta-analyze pooled sensitivity and specificity data for each ancillary investigation with at least two studies. Principal findings Thirty-nine eligible manuscripts assessing 18 unique ancillary investigations ( n = 866) were identified. The sensitivity and specificity ranged from 0.00 to 1.00 and 0.50 to 1.00, respectively. The quality of evidence was low to very low for all ancillary investigations, with the exception of radionuclide dynamic flow studies for which it was graded as moderate. Radionuclide scintigraphy using the lipophilic radiopharmaceutical 99m Tc-hexamethylpropyleneamine oxime (HMPAO) with or without tomographic imaging were the most accurate ancillary investigations with a combined sensitivity of 0.99 (95% highest density interval [HDI], 0.89 to 1.00) and specificity of 0.97 (95% HDI, 0.65 to 1.00). Conclusion The ancillary investigation for DNC in infants and children with the greatest accuracy appears to be radionuclide scintigraphy using HMPAO with or without tomographic imaging; however, the certainty of the evidence is low. Nonimaging modalities performed at the bedside require further investigation. Study registration: PROSPERO (CRD42021278788); registered 16 October 2021. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-023-02418-1.

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Pediatric Brain Death: Experience of a Single Center

Cited by 3 publications

References 39 publications

Evaluation of Brain Death in Children: A Single Center Experience

Evaluation of Brain Death in Children: A Single Center Experience

Prediction of Mortality in Pediatric Traumatic Brain Injury: Implementations from a Tertiary Pediatric Intensive Care Facility

Ancillary investigations for death determination in infants and children: a systematic review and meta-analysis

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