Describe and evaluate brain death determination across various intensive care units (ICUs) in a single institution and explore discrepancies in testing and documentation.

Failure to properly diagnose brain death is associated with substantial medical, ethical, and legal quandaries. Several medical societies are currently promoting standardization of the definition and determination of brain death worldwide and the documentation of such findings.

This is a retrospective chart review of the electronic medical record of adult patients diagnosed with brain death at a tertiary academic medical center over a 6 year period. Testing occurred in a neuroscience ICU (NSICU), surgical ICU (SICU), medical ICU (MICU), or a cardiovascular ICU (CVICU). Data was collected and grouped into categories: background/demographics, prerequisites, clinical testing (including apnea testing), imaging/ancillary studies, and documentation. Descriptive summary statistics were extracted in order to identify deviations from accepted guidelines set forth by the ºÃÉ«ÏÈÉú (AAN).

Records from 52 patients were analyzed (mean age: 50 ± 15 years; 60% women). The most common admission diagnosis was primary neurological injury (69%) followed by cardiac arrest (17%). Neurointensivists and neurologists performed the majority of testing (88%). Out of 52 patients, 11 (21%) met criteria of having all portions completed in accordance with AAN guidelines; 9 of these determinations occurred in the NSICU while the MICU and CVICU had 1 each. No determinations which occurred both outside the NSICU and by non-neurologists demonstrated comprehensive observance to AAN guidelines.

Significant variability exists in brain death testing across different ICU settings and amongst physicians of different specialties. Strict adherence to accepted guidelines occurred more frequently in the NSICU and when testing was performed by a neurologist or neurointensivist. There remains a significant opportunity for improvement and implementation of uniform practice parameters in determination and documentation of brain death.