Variability in brain death determination practices in children

Mejia, RE; Mm, Pollack

doi:10.1016/s1075-4210(96)80012-5

Cited by 12 publications

(25 citation statements)

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“…In 1995, Mejia and Pollack reported the variability of practice in pediatric ICUs. 7 Identified variations include a lack of apnea testing in 23% of cases, "controversial" apnea testing in 22% of cases, and other "contradictory" practices. Bell et al recently conducted a survey in the United Kingdom of neurocritical care experts, and found similarly variable practices.…”

Section: Discussionmentioning

confidence: 99%

Brief survey: Determining brain death in Canadian intensive care units

Doig

Young

Teitelbaum

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: Criteria for brain death were first described in 1968, and Canadian guidelines were published in 1988. However, international inconsistency persists in the process of determining brain death. We sought to determine self-reported practices and processes in the determination of brain death amongst Canadian intensive care unit (ICU) physicians.Methods: An email survey of members of the Canadian Critical Care Society was undertaken. A survey instrument was developed, then face and content validated prior to distribution.Results: Eighty eight responded (response rate = 49%), including adult and pediatric ICU physicians working in both tertiary referral (academic) and community hospitals. Most respondents admit patients with brain death to their ICUs. However, 9% reported refusing to admit this type of patient for reasons including inappropriate utilization of ICU resources (36%), and lack of either space or staff (32% and 29% of respondents, respectively). Community hospital-based ICU physicians were less likely to report a hospital policy on the determination of brain death (46% vs 78% of physicians in tertiary care hospitals). Nearly all physicians (96%) reported that a revised national standard and checklist for the determination of death would be useful. Conclusions:Nearly one quarter, and over one half of tertiary care and community hospitals (respectively) in Canada lack an institutional policy on neurological determination of brain death. Canadian ICU physicians are interested in a national standard for the determination of death, and establishment of processes that may improve the clinical determination of death by neurological criteria. Objectif

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Section: Discussionmentioning

confidence: 99%

Brief survey: Determining brain death in Canadian intensive care units

Doig

Young

Teitelbaum

et al. 2006

Can J Anesth/J Can Anesth

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“…Despite national and legal acceptance of the concept of brain death, these limitations have resulted in the lack of a standardized approach to determining brain death in children. [3][4][5][6][7][8][9] These issues are not unique to infants and children 10 nor limited to the United States. The American Academy of Neurology published guidelines to determine brain death in adults in 1995 which have been revised in 2010.…”

Section: Introductionmentioning

confidence: 99%

Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations

Nakagawa¹,

Ashwal²,

Mathur³

et al. 2011

Pediatrics

187

120

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OBJECTIVE: To review and revise the 1987 pediatric brain death guidelines. METHODS: Relevant literature was reviewed. Recommendations were developed using the GRADE system. CONCLUSIONS AND RECOMMENDATIONS: (1) Determination of brain death in term newborns, infants and children is a clinical diagnosis based on the absence of neurologic function with a known irreversible cause of coma. Because of insufficient data in the literature, recommendations for preterm infants less than 37 weeks gestational age are not included in this guideline.

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“…Adherence to contemporary AAN guidelines was followed strictly in only 45% of patient records and loosely in 37%. Prior studies noted poor documentation of compliance in brain death declarations for adults in British (59) and American (60) hospitals, and similar findings were observed in brain death declarations for children (61,62). Finally, studies have also shown a poor understanding of relevant concepts among many physicians involved in the declaration of brain death (22,23).…”

Section: The Evaluation Of Brain Death the Clinical Examinationmentioning

confidence: 60%

Radionuclide Evaluation of Brain Death in the Post-McMath Era

Zuckier

2016

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to (1) relate the diagnostic protocols and recommendations regarding the clinical diagnosis of brain death; (2) list the relative advantages and disadvantages of lipophilic and nonlipophilic blood flow radiopharmaceuticals for brain blood flow studies; and (3) consider how the nuclear medicine blood flow study could assist the clinician in making the difficult diagnosis of brain death.Financial Disclosure: The author of this article has indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through October 2019.The pronouncement of death is a determination of paramount social, legal, and ethical import. The novel construct of "brain death" was introduced 50 years ago, yet there persist gaps in understanding regarding this diagnosis on the part of medical caregivers and families. The tragic, much-publicized case of Jahi McMath typifies potential problems that can be encountered with this diagnosis and serves as an effective point of departure for discussion. This article recapitulates the historical development of brain death and the evolution of scintigraphic examinations as ancillary or confirmatory studies, emphasizing updated clinical and imaging practice guidelines and the current role of scintigraphy. The limitations of clinical and radionuclide studies are then reviewed. Finally, the article examines whether radionuclide examinations might be able to play an expanded role in the determination of brain death by improving accuracy and facilitating effective communication with family members.

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Variability in brain death determination practices in children

Cited by 12 publications

References 0 publications

Brief survey: Determining brain death in Canadian intensive care units

Brief survey: Determining brain death in Canadian intensive care units

Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations

Radionuclide Evaluation of Brain Death in the Post-McMath Era

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