Abstract Details

Title Outcomes, Predictors, and Time-trends of Ancillary Studies for the Determination of Brain Death

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 051

Objective We aimed to analyze the outcomes of ancillary studies, the factors associated with ancillary study performance, and the changes overtime in number of studies performed at a single academic institution.

Background Brain death (BD) diagnosis sometimes requires ancillary studies when the clinical criteria for BD cannot be satisfied.

Design/Methods In retrospective cohort of brain dead patients, we compared characteristics of patients who underwent ancillary studies with those who did not. Linear and logistic regression analyses were used to identify time-trends and predictors of ancillary study use.

Results Out of 140 brain dead patients, ancillary studies were performed in 84 patients (60%). The false-negative rate of all ancillary studies was 4% (5% of TCDs, 4% of nuclear studies, 0% of EEGs, and 17% of CTAs). Predictors of ancillary study use were female sex (OR 2.4 [CI 1.21-5.01], p=0.013) and the etiology of BD being HIBI [OR 2.9 [1.43-5.88], p= 0.003], nontraumatic ICH (OR 0.45 [0.21-0.96], p=0.039) or TBI (OR 0.22 [0.04-0.8], p=0.031). After adjusting for sex and performance of apnea test, only HIBI as the etiology of BD was a predictor of ancillary study use (adjusted OR 3.2 [1.3-8.3], p= 0.012). Additionally, neurologists were as likely to utilize ancillary studies as non-neurologists. Over the study period, the total number of ancillary studies used did not significantly change; however, the number of EEGs significantly decreased with time (OR per 1-year increase 0.67 [0.49- 0.90], p=0.014). There was no difference in the time from neurological injury to BD declaration when comparing different types of ancillary studies.

Conclusions In this study, HIBI as the etiology of BD predicts the use of ancillary studies for BD determination, and neurologists were as likely to utilize ancillary studies as non-neurologists. Recently, the use of EEG for BD determination has decreased, likely reflecting a significant concern regarding its validity and reliability.

Authors/Disclosures
Ibrahim Migdady, MD PRESENTER	Dr. Migdady has nothing to disclose.
Aaron Shoskes, DO (University of Utah)	Dr. Shoskes has nothing to disclose.
Moein Amin, MD (Cleveland Clinic)	Dr. Amin has nothing to disclose.
Catherine Hassett, MD	Dr. Hassett has nothing to disclose.
Alex D. Rae-Grant, MD, FAAN (Ebsco Information Services)	Dr. Rae-Grant has received publishing royalties from a publication relating to health care. Dr. Rae-Grant has received publishing royalties from a publication relating to health care.
Sung-Min Cho	No disclosure on file
Pravin George, DO (Cleveland Clinic)	Dr. George has nothing to disclose.

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