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. 2019 Feb 26;92(9):e888-e894.
doi: 10.1212/WNL.0000000000007009. Epub 2019 Jan 25.

Variability in reported physician practices for brain death determination

Sherri A Braksick  1 , Christopher P Robinson  2 , Gary S Gronseth  2 , Sara Hocker  2 , Eelco F M Wijdicks  2 , Alejandro A Rabinstein  2
Affiliations

Variability in reported physician practices for brain death determination

Sherri A Braksick et al. Neurology. .

Abstract

Objectives: The degree of training and variability in the clinical brain death examination performed by physicians is not known.

Methods: Surveys 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.

Results: Of 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.

Conclusions: There 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.

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Figures

Figure 1
Figure 1. Specialty distribution of survey respondents
Figure 2
Figure 2. Frequency of completion of brain death examination components
Figure 3
Figure 3. Selection of ancillary tests
CTA = CT angiography; MRA = magnetic resonance angiography; TCD = transcranial Doppler.
See this image and copyright information in PMC

Comment in

References

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