Wang Hilary H, Varelas Panayiotis N, Henderson Galen V, Wijdicks Eelco F M, Greer David M
From the Department of Neurology (H.H.W., D.M.G.), Yale University School of Medicine, New Haven, CT; Department of Neurology (P.N.V.), Henry Ford Hospital, Detroit, MI; Department of Neurology (G.V.H.), Harvard Medical School, Cambridge, MA; and Department of Neurology (E.F.M.W.), Mayo Clinic, Rochester, MN.
Neurology. 2017 Feb 7;88(6):562-568. doi: 10.1212/WNL.0000000000003597. Epub 2017 Jan 11.
To demonstrate that progress has been made in unifying brain death determination guidelines in the last decade by directly comparing the policies of the US News and World Report's top 50 ranked neurologic institutions from 2006 and 2015.
We solicited official hospital guidelines in 2015 from these top 50 institutions, generated summary statistics of their criteria as benchmarked against the American Academy of Neurology Practice Parameters (AANPP) and the comparison 2006 cohort in 5 key categories, and statistically compared the 2 cohorts' compliance with the AANPP.
From 2008 to 2015, hospital policies exhibited significant improvement (p = 0.005) in compliance with official guidelines, particularly with respect to criteria related to apnea testing (p = 0.009) and appropriate ancillary testing (p = 0.0006). However, variability remains in other portions of the policies, both those with specific recommendation from the AANPP (e.g., specifics for ancillary tests) and those without firm guidance (e.g., the level of involvement of neurologists, neurosurgeons, or physicians with education/training specific to brain death in the determination process).
While the 2010 AANPP update seems to be concordant with progress in achieving greater uniformity in guidelines at the top 50 neurologic institutions, more needs to be done. Whether further interventions come as grassroots initiatives that leverage technological advances in promoting adoption of new guidelines or as top-down regulatory rulings to mandate speedier approval processes, this study shows that solely relying on voluntary updates to professional society guidelines is not enough.
通过直接比较2006年和2015年美国《新闻与世界报道》排名前50的神经科机构的政策，证明在过去十年中统一脑死亡判定指南方面取得了进展。
我们于2015年向这50家顶尖机构征集了官方医院指南，生成了以美国神经病学学会实践参数（AANPP）为基准的标准摘要统计数据，并在5个关键类别中对2006年的比较队列进行了统计，然后对两个队列与AANPP的合规情况进行了统计比较。
从2008年到2015年，医院政策在遵守官方指南方面有显著改善（p = 0.005），特别是在与呼吸暂停测试相关的标准（p = 0.009）和适当的辅助测试方面（p = 0.0006）。然而，政策的其他部分仍存在差异，既有AANPP有具体建议的部分（如辅助测试的具体内容），也有没有明确指导的部分（如神经科医生、神经外科医生或在判定过程中接受过脑死亡特定教育/培训的医生的参与程度）。
虽然2010年AANPP的更新似乎与排名前50的神经科机构在实现指南更大程度统一方面的进展一致，但仍有更多工作要做。无论是通过利用技术进步促进新指南采用的基层倡议，还是通过自上而下的监管裁决来强制加快审批流程的进一步干预措施，本研究表明，仅依靠专业协会指南的自愿更新是不够的。
