Brain-death criteria currently used by pediatric intensivists.
A survey was done to identify how pediatric intensivists determine brain death in children. Forty-nine pediatric intensive-care units (PICUs) were surveyed. The questionnaire explored the following areas: 1) clinical and confirmatory studies performed, 2) types of physicians involved, and 3) reevaluation intervals. Thirty-four centers responded to the questionnaire. Sixty-nine percent were children's hospitals, and 94% were university affiliates. The mean number of PICU beds was 17, with a mean admission rate of 890 patients per year, and the mean mortality rate for these units was 6%. There was general agreement on the sufficiency of clinical examination to determine cortical and brain-stem function. All the pediatric intensivists noted that a positive apnea test, absent cephalic reflexes, fixed and dilated pupils, and no motor response to pain were reliable signs of brain death. Radionuclide cerebral-flow scan and EEG were the confirmatory tests routinely used. Most physicians (77%) felt a second clinical examination was required within 12 to 24 hours. The opinion of more than one physician, one of whom was a neurospecialist, was required in 80% of the surveyed institutions.
Lynch
J
J
Marshall University School of Medicine, Pediatric Department, Huntington, West Virginia.
Eldadah
M K
MK
D001783:Blood Flow Velocity; D001926:Brain Death / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002170:Canada; D015984:Causality; D002560:Cerebrovascular Circulation; D002648:Child; D002985:Clinical Protocols / Q000592:standards; D003422:Critical Care / Q000379:methods / Q000592:standards*; D004569:Electroencephalography; D006742:Hospital Bed Capacity; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006785:Hospitals, University; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D009460:Neurologic Examination; D010343:Patient Admission / Q000706:statistics & numerical data; D010372:Pediatrics / Q000379:methods / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011877:Radionuclide Imaging; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014481:United States