Variability in reported physician practices for brain death determination

Abstract

ObjectivesThe degree of training and variability in the clinical brain death examination performed by physicians is not known.MethodsSurveys were distributed to physicians (including physicians-in-training) practicing at 3 separate academic medical centers. Data, including level of practice, training received in completion of a brain death examination, examination components performed, and use of confirmatory tests were collected. Data were evaluated for accuracy in the brain death examination, self-perceived competence in the examination, and indications for confirmatory tests.ResultsOf 225 total respondents, 68 reported completing brain death examinations in practice. Most physicians who complete a brain death examination reported they had received training in how to complete the examination (76.1%). Seventeen respondents (25%) reported doing a brain death examination that is consistent with the current practice guideline. As a part of their brain death assessment, 10.3% of physicians did not report completing an apnea test. Of clinicians who obtain confirmatory tests on an as-needed basis, 28.3% do so if a patient breathes during an apnea test, a clinical finding that is not consistent with brain death.ConclusionsThere is substantial variability in how physicians approach the adult brain death examination, but our survey also identified lack of training in nearly 1 in 4 academic physicians. A formal training course in the principles and proper technique of the brain death examination by physicians with expert knowledge of this clinical assessment is recommended.

Apnea Testing for the Determination of Brain Death: A Systematic Scoping Review

“…In a recent survey from the USA, 30% of responders reported completing BD exams in their practice, and 76.1% reported to have had training on how to complete the exam. However, 28.3% of them ordered a confirmatory test in patients who, during the AT, take breaths [87]. Similarly, recent large studies across the world have demonstrated this.…”

Brain Death Determination: An Interprofessional Simulation to Determine Brain Death and Communicate with Families Focused on Neurology Residents

“…2 Despite clear guidelines, significant practice variation exists, some of which directly compromises patient care. 3,4 Such variation produces serious consequences for patients and fosters distrust in brain death determination by the public. 5 All neurology residents are expected to be competent in accurately performing a brain death examination and diagnosing brain death by the completion of their residency.…”

“… 2 Despite clear guidelines, significant practice variation exists, some of which directly compromises patient care. 3 , 4 Such variation produces serious consequences for patients and fosters distrust in brain death determination by the public. 5 …”

A Qualitative Identification of Gaps in Understanding About Brain Death Among Trainees, Health Care Personnel and Families at an Academic Medical Center

“…Despite these well-defined and validated AAN guidelines, there is marked variability in the practice of brain death declaration at a national 6 and international 7 level. Surveys of major United States center protocols show deficits in removing confounding factors and using appropriate testing and brain death documentation.…”

“…Surveys of major United States center protocols show deficits in removing confounding factors and using appropriate testing and brain death documentation. 6,8 A number of explanations for this variability have been proposed: hospital infrastructure, public misinformation, and lack of exposure and comfort across medical subspecialties. 8,9 A common theme is a lack of formal education in brain death declaration among trainees and an urgency for improved exposure and education to brain death declaration.…”