title: Accuracy of clinical evaluation in the determination of brain death.
abstract: BACKGROUND
  The accuracy of the clinical diagnosis of brain death has never been established.
  
  
  METHODS
  Seventy-one consecutive clinically brain dead patients were studied retrospectively. Inclusion criteria were complete cessation of brain function with profound coma of known cause, complete absence of brain stem reflexes, and apnea, all persisting for a least 6 hours. A formal apnea test with a documented Pco2 of > 60 mm Hg was required. All evaluations were done by experienced neurosurgery or neurology resident or staff physicians. The clinical diagnosis was compared with the results of radionuclide angiography and with the clinical course and final outcome.
  
  
  RESULTS
  Seventy patients had no arterial blood flow on radionuclide angiography. One blood flow study was considered to have yielded a false-negative result. No patient recovered or survived.
  
  
  CONCLUSIONS
  The clinical diagnosis of brain death is highly reliable when made by experienced examiners using established criteria. In this study, the accuracy was 100%.
authors.affiliation: Department of Radiology, University of Mississippi Medical Center, Jackson 39216, USA.
authors.forename: W M
authors.initials: WM
authors.lastname: Flowers
authors.forename: B R
authors.initials: BR
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001926:Brain Death / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011875:Radionuclide Angiography; D015203:Reproducibility of Results; D012189:Retrospective Studies