title: [Ancillary procedures in the diagnostics of brain death. Utilization, results and consequences in northeastern Germany].
abstract: BACKGROUND
  According to the German Medical Council guidelines, the proof of irreversible brain death can be carried out using clinical investigations alone or can necessitate the use of ancillary tests (ATs), depending on the patient age and type of brain injury.
  
  
  METHODS
  Retrospective evaluation of the diagnostics of irreversible brain death, which were carried out using ATs according to the third edition of the guidelines between January 2001 and December 2010 in Berlin, Brandenburg and Mecklenburg-Western Pomerania and were registered at the German National Foundation for Organ Transplantation.
  
  
  RESULTS
  In 1401 patients (aged 0-94 years) a total of 1636 ATs were carried out. The most frequently used additional procedure for the first AT was an electroencephalogram (EEG) in 71.7 %. Confirmatory results regarding irreversibility were reported for 93.6 % of the initial ATs. Negative results of ATs were less common with primary supratentorial brain lesions (2.9 %) compared to infratentorial lesions (13.7 %), secondary hypoxic brain damage (8.1 %) and children younger than 2 years old (18.5 %). Regardless of the AT results, a return of clinical brain function was never documented. The timing, type and repetition of ATs were variable. In most cases the diagnostic process was clearly accelerated by the use of ATs but was significantly delayed in 10.1 % compared to a purely clinical proof of irreversible brain death.
  
  
  CONCLUSIONS
  ATs by themselves do not provide evidence of the cessation of all brain functions. Instead, they are used to prove the irreversibility of the clinically defined syndrome. For patients over 2 years old and in the absence of primary brainstem lesions, clinical re-assessment and ATs are considered to be equally accurate in demonstrating irreversibility. A standardization of diagnostic procedures between hospitals would be desirable.
authors.affiliation: Klinik für Neurologie, Alexianer St. Josefs-Krankenhaus Potsdam-Sanssouci, Allee nach Sanssouci 7, 14471, Potsdam, Deutschland. o.hoffmann@alexius.de.
authors.forename: O
authors.initials: O
authors.lastname: Hoffmann
authors.affiliation: Abteilung Neurologie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Masuhr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001926:Brain Death / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003943:Diagnostic Techniques, Neurological / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012042:Registries; D016019:Survival Analysis; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014600:Utilization Review; D055815:Young Adult
keywords: Brain death; Diagnosis; EEG; Intensive care; Prognosis