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Variability in reported physician practices for brain death determination.
Neurology. 2019 02 26;92(9):e888-e894
Authors: Braksick SA, Robinson CP, Gronseth GS, Hocker S, Wijdicks EFM, Rabinstein AA
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.
PMID: 30804063 [PubMed - indexed for MEDLINE]