Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH.
Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Crit Care Med. 2021 Sep 1;49(9):e840-e848. doi: 10.1097/CCM.0000000000005035.
Brain death determination often requires ancillary studies when clinical determination cannot be fully or safely completed. We aimed to analyze the results of ancillary studies, the factors associated with ancillary study performance, and the changes over time in number of studies performed at an academic health system.
Retrospective cohort.
Multihospital academic health system.
Consecutive adult patients declared brain dead between 2010 and 2020.
None.
Of 140 brain death patients, ancillary studies were performed in 84 (60%). The false negative rate of all ancillary studies was 4% (5% of transcranial Doppler ultrasounds, 4% of nuclear studies, 0% of electroencephalograms, and 17% of CT angiography). In univariate analysis, ancillary study use was associated with female sex (odds ratio, 2.4; 95% CI, 1.21-5.01; p = 0.013) and the etiology of brain death being hypoxic-ischemic brain injury (odds ratio, 2.9; 95% CI, 1.43-5.88; p = 0.003), nontraumatic intracranial hemorrhage (odds ratio, 0.45; 95% CI, 0.21-0.96; p = 0.039), or traumatic brain injury (odds ratio, 0.22; 95% CI, 0.04-0.8; p = 0.031). In multivariable analysis, female sex (odds ratio, 5.7; 95% CI, 2.56-15.86; p = 0.004), the etiology of brain death being hypoxic-ischemic brain injury (odds ratio, 3.2; 95% CI, 1.3-8.8; p = 0.015), and the neurologists performing brain death declaration (odds ratio, 0.08; 95% CI, 0.004-0.64; p = 0.034) were factors independently associated with use of ancillary studies. Over the study period, the total number of ancillary studies performed each year did not significantly change; however, the number of electroencephalograms significantly decreased with time (odds ratio per 1-yr increase, 0.67; 95% CI, 0.49-0.90; p = 0.014).
A large number of ancillary studies were performed despite a clinical determination of brain death; patients with hypoxic-ischemic brain injury are more likely to undergo ancillary studies for brain death determination, and neurologists were less likely to use ancillary studies for brain death. Recently, the use of electroencephalograms for brain death determination has decreased, likely reflecting significant concerns regarding its validity and reliability.
当临床判定无法完全或安全完成时，脑死亡的判定通常需要辅助研究。我们旨在分析辅助研究的结果、与辅助研究执行相关的因素，以及在学术医疗系统中执行的研究数量随时间的变化。
回顾性队列研究。
多医院学术医疗系统。
2010 年至 2020 年间连续被判定为脑死亡的成年患者。
无。
在 140 名脑死亡患者中，有 84 名（60%）进行了辅助研究。所有辅助研究的假阴性率为 4%（经颅多普勒超声的 5%、核研究的 4%、脑电图的 0%和 CT 血管造影的 17%）。在单变量分析中，辅助研究的使用与女性性别（比值比，2.4；95%置信区间，1.21-5.01；p = 0.013）和脑死亡病因是缺氧缺血性脑损伤（比值比，2.9；95%置信区间，1.43-5.88；p = 0.003）、非创伤性颅内出血（比值比，0.45；95%置信区间，0.21-0.96；p = 0.039）或创伤性脑损伤（比值比，0.22；95%置信区间，0.04-0.8；p = 0.031）有关。在多变量分析中，女性性别（比值比，5.7；95%置信区间，2.56-15.86；p = 0.004）、脑死亡病因是缺氧缺血性脑损伤（比值比，3.2；95%置信区间，1.3-8.8；p = 0.015）和进行脑死亡判定的神经科医生（比值比，0.08；95%置信区间，0.004-0.64；p = 0.034）是与辅助研究使用相关的独立因素。在研究期间，每年进行的辅助研究总数没有显著变化；然而，脑电图的数量随着时间的推移而显著减少（每增加 1 年的比值比，0.67；95%置信区间，0.49-0.90；p = 0.014）。
尽管临床判定为脑死亡，但仍进行了大量的辅助研究；患有缺氧缺血性脑损伤的患者更有可能接受辅助研究以确定脑死亡，而神经科医生则不太可能使用辅助研究来确定脑死亡。最近，脑电图用于脑死亡的判定有所减少，这可能反映了人们对其有效性和可靠性的严重关注。
