Auditory brain stem responses in the detection of brain death.
OBJECTIVE
We evaluated comatose patients by auditory brain stem responses (ABR) to determine the role of ABR in the diagnosis of impending brain death.


METHODS
Sixty comatose patients in the intensive care unit were evaluated by brain stem evoked response audiometry. Correlations were sought between the absence or presence of ABRs and the presenting pathology, the Glasgow Coma Scale (GCS) scores, and ultimate diagnoses.


RESULTS
The brain stem responses were totally absent in 41 patients. Presence of wave I could be obtained in only 10 patients. All the waveforms were found in nine patients; however, in eight patients the potentials disappeared as the GCS scores decreased to 3. Detection of wave I alone strongly suggested dysfunction of the brain stem. However, loss of wave I particularly in trauma patients aroused doubt as to whether the absence was associated with auditory end organ injury or brain stem dysfunction.


CONCLUSIONS
The results suggest that evaluation of ABR may support brain death in a comatose patient (i) when wave I is present alone, (ii) the absence of wave I is accompanied by a documented auditory end organ injury, or (iii) when previously recorded potentials are no longer detectable.
Ozgirgin
O Nuri
ON
Department of Otolaryngology, Medicine Faculty of Başkent University, Bahçelievler, Ankara, Turkey. ozgirgin@politzersociety.org
Ozçelik
Tuncay
T
Sevimli
Nilay Kizilkaya
NK
D000293:Adolescent; D000328:Adult; D000368:Aged; D001926:Brain Death / Q000175:diagnosis* / Q000503:physiopathology; D001933:Brain Stem / Q000293:injuries / Q000503:physiopathology*; D016057:Evoked Potentials, Auditory, Brain Stem; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests