Brain death epidemiology in Uruguay and utilization of the Glasgow coma score in acute brain injured patients as a predictor of brain death.
OBJECTIVE
The knowledge of brain death (BD) epidemiology and the acute brain injury (ABI) progression profile are relevant to improve public health programs, organ procurement strategies, as well as intensive care unit (ICU) protocols aiming to increase the detection of potential donors. The aim of this study was to analyze the BD epidemiology and the ABI progression profile among subjects admitted to ICUs with a Glasgow Coma Score (GCS) < or = 8.


METHODS
This was a prospective, observational study of BD reported to the National Institute of Donation and Transplantation from 2000-2006. The patients with ABI and GCS < or = 8 who were admitted to 5 ICUs with In-hospital Transplant Coordination were analyzed over the period of 2005-2007.


RESULTS
The BD detection increased from 28.7 in 2000 to 58.5 BD pmp in 2006. The real donor global rate increased from 10 to 24.6 pmp from 2000 to 2006. The ABI patients with GCS < or = 8 had a global mortality rate of 56%, including 23.4% who evolved to BD.


CONCLUSIONS
This study showed a 200% increment of detected BD and 150% of real donors, although these results are still below the international figures. GCS follow-up appeared to be a good tool to predict the BD outcome. The follow-up of patients with ABI allowed us to improve our BD detection strategy.
Mizraji
R
R
Instituto Nacional de Donación y Trasplantes, National Institute of Donation and Transplants, Rafael Patoriza 1322, CP 11300, Montevideo, Uruguay. rmizraji@gmail.com
Perez-Protto
S
S
Etchegaray
A
A
Castro
A
A
Lander
M
M
Buccino
E
E
Severo
L
L
Alvarez
I
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D001926:Brain Death / Q000175:diagnosis*; D001930:Brain Injuries / Q000453:epidemiology* / Q000401:mortality; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005190:Family; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016312:Treatment Refusal; D014583:Uruguay; D055815:Young Adult