A survey on patients admitted in severe coma: implications for brain death identification and organ donation.

OBJECTIVE

To identify factors to improve the identification of brain dead patients in intensive care units (ICUs).

DESIGN AND SETTING

Prospective study conducted in 79 ICUs in 54 hospitals.

PATIENTS

All hospitalized patients with a Glasgow Coma Scale (GCS) score less than 8.

MEASUREMENTS AND RESULTS

During the study period hospital staff completed a form for each patient with a GCS less than 8. Hospital information units provided us with statistics from the discharge forms. The characteristics of the hospitals were also recorded. We included a total of 792 patients with a GCS less than 8; 120 of these patients were diagnosed as being clinically brain dead (15.1%). These patients accounted for 11.8% of the comatose patients in ICUs, 11.7% of the deaths occurring in ICUs, and 3.3% of the deaths that occurred in the hospital during the study period. Two multivariate linear regressions were performed to predict the number of clinically brain dead patients in the ICUs. The regression analyses included causes of death or causes of coma, and hospital characteristics. The presence of a coordination team and the number of transplant coordinators were positively associated with the number of brain dead patients in both models. The number of patients carried to the ICU by a mobile emergency unit was also positively associated in the model with causes of coma.

CONCLUSIONS

Increasing the number of hospital coordinators and collaboration with mobile emergency units should lead to the identification of more brain dead patients among comatose patients in ICUs.