title: Prediction of evolution toward brain death upon admission to ICU in comatose patients with spontaneous intracerebral hemorrhage using simple signs.
abstract: The aim of the study was to identify the predictors of brain death (BD) upon admission to the intensive care unit (ICU) of comatose patients with spontaneous intracerebral hemorrhage (ICH). Patients admitted in our ICU from 2002 to 2010 for spontaneous ICH and placed under mechanical ventilation were retrospectively analyzed. Of the 72 patients, 49% evolved to BD, 39% died after withdrawal of life support, and 12% were discharged alive. The most discriminating characteristics to predict BD were included in two models; Model 1 contained ≥3 abolished brainstem responses [adjusted odds ratios (OR) = 8.4 (2.4, 29.1)] and the swirl sign on the baseline CT-scan [adjusted OR = 5.0 (1.6, 15.9)] and Model 2 addressed the abolition of corneal reflexes [unilateral/bilateral: adjusted OR = 4.2 (0.9, 20.1)/8.8 (2.4, 32.3)] and the swirl sign on the baseline CT-scan [adjusted OR = 6.2 (1.9, 20.0)]. Two scores predicting BD were created (sensitivity: 0.89 and 0.88, specificity: 0.68 and 0.65). Risk of evolution toward BD was classified as low (corneal reflexes present and no swirl sign), high (≥1 corneal reflexes abolished and swirl sign), and intermediate. Simple signs at ICU admission can predict BD in comatose patients with ICH and could increase the potential for organ donation.
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, 75571 Paris Cedex 12, France. galbois@gmail.com
authors.forename: Arnaud
authors.initials: A
authors.lastname: Galbois
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Boëlle
authors.forename: Elodie
authors.initials: E
authors.lastname: Hainque
authors.forename: Marianne
authors.initials: M
authors.lastname: Raynal
authors.forename: Julien
authors.initials: J
authors.lastname: Cazejust
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Baudel
authors.forename: Hafid
authors.initials: H
authors.lastname: Ait-Oufella
authors.forename: Mikael
authors.initials: M
authors.lastname: Alves
authors.forename: Naïke
authors.initials: N
authors.lastname: Bigé
authors.forename: Eric
authors.initials: E
authors.lastname: Maury
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.forename: Georges
authors.initials: G
authors.lastname: Offenstadt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001926:Brain Death / Q000175:diagnosis* / Q000503:physiopathology*; D001933:Brain Stem / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D003128:Coma / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D010343:Patient Admission; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D009927:Tissue and Organ Procurement; D014057:Tomography, X-Ray Computed