Glasgow coma scale 7 or less surveillance program for brain death identification in Argentina: Epidemiology and outcome.
BACKGROUND
In Argentina, the rate of cadaveric organ donation per million inhabitants has recently increased to 10.5 (it was previously <7).


OBJECTIVE
To overcome this challenge, the National Institute for Organ Donation and Transplantation (INCUCAI) created a proactive donor detection plan performed by intensive care unit (ICU) physicians (hospital transplantation coordinators) from 90 selected hospitals across the country.


METHODS
A prospective, observational study of patients in severe coma status was conducted from September 2003 to December 2005. We enrolled hospitalized patients who displayed a Glasgow Coma Scale (GCS) of 7 or less and who were admitted to ICUs. Data included demographics, etiology of coma, cardiac arrest, brain death, discharge or derivation, and positive/negative donation.


RESULTS
Among 9841 enrolled patients, we excluded 498 who were discharged to another hospital or had unknown outcomes, leaving 9343 for analysis including 64% males and 36% females of overall mean age 50 +/- 19 years (adults) and 5 +/- 4 years (children). Herein, we have highlighted the high risk of death during the first 2 days in the ICU of patients with GCS 7 or less. Gunshot to the head-injured patients and those with hemorrhagic strokes were less likely to survive. In this study, cardiac arrest events and organ donors (OD) GCS 7 or less ratios emerged as quality control markers of ICU care, unraveling problems of potential donor maintenance or inadequate policies.


CONCLUSIONS
The GCS 7 or less surveillance program seemed to be a valuable tool for identifying organ donors and potentially treatable events, such as the high rate of cardiac arrest observed in this study.
Bustos
J L
JL
National Institute for Organ Donation and Transplantation and INCUCAI, Buenos Aires, Argentina.
Surt
K
K
Soratti
C
C
D000063:Accidents, Traffic; D001118:Argentina; D001926:Brain Death / Q000175:diagnosis*; D001932:Brain Neoplasms; D002543:Cerebral Hemorrhage; D015331:Cohort Studies; D006259:Craniocerebral Trauma; D015600:Glasgow Coma Scale; D006801:Humans; D015588:Observer Variation; D015203:Reproducibility of Results; D014019:Tissue Donors / Q000706:statistics & numerical data*