Variability among hospital policies for determining brain death in adults*

Powner, David J.; Hernandez, Mike; Rives, Terry

doi:10.1097/01.ccm.0000127265.62431.0d

Cited by 83 publications

(56 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…8 Currently, the guidelines and methods used to determine the presence of brain death may vary by defi nition and compliance based on law, legal precedent, or individual hospital policy. [9][10][11] In an international survey of standards used to determine brain death across 80 nations, a national standard existed in only 69% of countries, with only 59% requiring apnea testing. 12 Further ancillary testing (eg, intracranial blood fl ow measured by cerebral angiogram by either CT scan, MRI scan, or Doppler fl ow studies; EEG; somatosensoryevoked potentials; or bispectral index) was required in only 40% of countries to confi rm the clinical diagnosis.…”

Section: Brain Death and Western Medicinementioning

confidence: 99%

Brain Death and Islam

Miller

Ziad-Miller

Elamin

2014

CHEST

View full text Add to dashboard Cite

show abstract

Section: Brain Death and Western Medicinementioning

confidence: 99%

Brain Death and Islam

Miller

Ziad-Miller

Elamin

2014

CHEST

View full text Add to dashboard Cite

show abstract

“…The purpose of the AHA database is to generate a comprehensive and inclusive overview of hospitals while permitting the tracking of hospital performance over time. AHA data have been extensively used to study hospitalbased outcomes [17], hospital policies [18], and reimbursement [19].…”

Section: Data Sourcesmentioning

confidence: 99%

Predictors of Clostridium difficile colitis infections in hospitals

et al. 2007

View full text Add to dashboard Cite

Hospital-level predictors of high rates of 'Clostridium difficile-associated disease' (CDAD) were evaluated in over 2300 hospitals across California, Arizona, and Minnesota. American Hospital Association data were used to determine hospital characteristics associated with high rates of CDAD. Significant correlations were found between hospital rates of CDAD, common infections and other identified pathogens. Hospitals in urban areas had higher average rates of CDAD; yet, irrespective of geographic location, hospital rates of CDAD were associated with other infections. In addition, hospitals with 'high CDAD' rates had slower turnover of beds and were more likely to offer transplant services. These results reveal large differences in rates of CDAD across regions. Hospitals with high rates of CDAD have high rates of other common infections, suggesting a need for broad infection control policies. KeywordsArizona, California, clostridium difficile, cross infection, enterocolitis, pseudomembranous, geography, hospitals, humans, Minnesota, risk factors, urban population SUMMARYHospital-level predictors of high rates of ' Clostridium difficile-associated disease ' (CDAD) were evaluated in over 2300 hospitals across California, Arizona, and Minnesota. American Hospital Association data were used to determine hospital characteristics associated with high rates of CDAD. Significant correlations were found between hospital rates of CDAD, common infections and other identified pathogens. Hospitals in urban areas had higher average rates of CDAD ; yet, irrespective of geographic location, hospital rates of CDAD were associated with other infections. In addition, hospitals with 'high CDAD ' rates had slower turnover of beds and were more likely to offer transplant services. These results reveal large differences in rates of CDAD across regions. Hospitals with high rates of CDAD have high rates of other common infections, suggesting a need for broad infection control policies.

show abstract

“…[1][2][3][4] Most guidelines emphasize that brain death is a clinical diagnosis requiring exclusion of confounding factors, presence of an irreversible coma without motor responses, lack of all brainstem reflexes, and apnea. 1,5,6 Apnea should be confirmed with an apnea test, which verifies a lack of spontaneous respiration during induced acute hypercarbia.…”

Section: Résumémentioning

confidence: 99%

Should ancillary brain blood flow analyses play a larger role in the neurological determination of death?

Roberts

MacCulloch

Versnick

et al. 2010

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose We present two patients who regained spontaneous respiration following clinical neurological determination of death (NDD) while ancillary radiological imaging demonstrated brain blood flow. Clinical features A 26-yr-old male with chronic otitis media presented with a Glasgow Coma Scale (GCS) score of 3 and fixed 7-mm pupils. Computed tomography demonstrated right-sided mastoiditis and a temporal lobe abscess associated with uncal herniation. The patient was diagnosed brain dead seven-hr later when motor responses and brainstem reflexes were absent and his apnea test was positive. Approximately 28-hr after NDD, during post-declaration organ resuscitation, the patient regained spontaneous respiration and magnetic resonance imaging revealed brain blood flow. Spontaneous respirations persisted for five-days before cardiovascular collapse occurred. In the second case, a 50-yr-old female presented with a GCS score of 3 and fixed 6-mm pupils following a traumatic brain injury and a five-minute cardiac arrest. The patient was deemed clinically brain dead six-hr later when physical examination revealed absent motor responses and brainstem reflexes and her apnea test was positive. As confirmation of brain death, a cerebral radionuclide angiogram was performed, which surprisingly revealed intracranial arterial flow. During organ resuscitation, 11-hr after NDD, the patient regained spontaneous respiration. She expired hours after family decision to withdraw treatment. Conclusion For both patients, several unrecognized confounding factors for NDD were present. These cases illustrate the difficulties encountered by experienced clinicians in determining brain death using clinical criteria alone, and they suggest that more routine use of ancillary brain blood flow analyses should be recommended. RésuméObjectif Nous pre´sentons les cas de deux patients qui ont recommence´a`respirer spontane´ment apre`s avoir reçu un diagnostic de de´ce`s neurologique clinique alors que l'imagerie radiologique secondaire de´montrait un de´bit sanguin ce´re´bral. É léments cliniques Un homme de 26 ans souffrant d'otite moyenne chronique s'est pre´sente´avec un score de 3 sur l'e´chelle de coma de Glasgow (GCS) et des pupilles fixes a`7 mm. La tomodensitome´trie a montre´une

show abstract

Variability among hospital policies for determining brain death in adults*

Cited by 83 publications

References 26 publications

Brain Death and Islam

Brain Death and Islam

Predictors of Clostridium difficile colitis infections in hospitals

Should ancillary brain blood flow analyses play a larger role in the neurological determination of death?

Contact Info

Product

Resources

About