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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.
Glossary
- CI=
- confidence interval
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 401
- Received August 6, 2018.
- Accepted in final form October 19, 2018.
- © 2019 American Academy of Neurology
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Letters: Rapid online correspondence
- Author response: Variability in reported physician practices for brain death determination
- Author response: Variability in brain death determination
- Inappropriate use of ancillary tests for brain death determination
- Variability in brain death determination
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