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Practice variability in brain death determination: a call to action.
Shappell, Claire N; Frank, Jeffrey I; Husari, Khalil; Sanchez, Matthew; Goldenberg, Fernando; Ardelt, Agnieszka.
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  • Shappell CN; From the Pritzker School of Medicine (C.N.S., M.S.), University of Chicago; and Department of Neurology (J.I.F., K.H., F.G., A.A.), University of Chicago Medicine, IL.
Neurology ; 81(23): 2009-14, 2013 Dec 03.
Article en En | MEDLINE | ID: mdl-24198290
OBJECTIVE: To characterize the present state of brain death (BD) determination in actual practice relative to contemporary American Academy of Neurology (AAN) guidelines. METHODS: We reviewed the charts of all adult (16 years and older) BD organ donors during 2011 from 68 heterogeneous hospitals in the Midwest United States. Data were collected across 5 categories: guideline performance, preclinical testing, clinical examination, apnea testing, and use of ancillary tests. Practice within categories and overall adherence to AAN guidelines were assessed. RESULTS: Two hundred twenty-six BD organ donors were included. Practice exceeded recommendations in guideline performance but varied widely and deviated from AAN guidelines in all other categories. One hundred two (45.1%) had complete documentation of brainstem areflexia and absent motor response. One hundred sixty-six (73.5%) had completed apnea testing. Of the 60 without completed apnea testing, 56 (93.3%) had ancillary tests consistent with BD. Overall, 101 (44.7%) strictly and 84 (37.2%) loosely adhered to contemporary AAN guidelines. CONCLUSIONS: There is wide variability in the documentation of BD determination, likely reflecting similar variability in practice. This is a call for improved documentation, better uniformity of policies, and comprehensive and strategically targeted educational initiatives to ensure consistently contemporary approaches to BD determination in every patient.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Donantes de Tejidos / Muerte Encefálica / Guías de Práctica Clínica como Asunto / Hospitales Tipo de estudio: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Neurology Año: 2013 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Donantes de Tejidos / Muerte Encefálica / Guías de Práctica Clínica como Asunto / Hospitales Tipo de estudio: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Neurology Año: 2013 Tipo del documento: Article Pais de publicación: Estados Unidos