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Abstract Details

Brain Death: The Consequence of a 2nd Test
Neuro Trauma and Critical Care
P1 - Poster Session 1 (8:00 AM-9:00 AM)
2-004
To determine the effects of requiring a confirmatory Brain Death Test (BDT).
The 2023 AAN BD/DNC Guideline states that to diagnose brain death in adults, a second clinician may perform a separate and independent exam (Level C), but only one exam must be performed (Level A). 65.9% of hospitals require two separate tests to diagnose BD/DNC.
In a multi-hospital system over 10 years, we used ICD-9/10 codes to identify adults who had undergone a BDT. We retrospectively analyzed the documentation of a separate second test (required by hospital protocol, but no minimum time needed), outcome of testing, time between tests, and cases in which testing was halted.
We identified 331 patients with an ICD code for BD/DNC. 298 patients had two tests as required by hospital protocol. In all cases, the second test confirmed the findings of the first. A median of 6 hours elapsed between the first and second BDT (IQR 1-8). 43% of patients waited 6-12 hours, 20% waited 12-24 hours and 2% of patients had more than a 24 hour period between tests. 33 patients (10%) had only 1 clinical brain death exam. Reasons for incomplete testing included clinical deterioration (2 cases), protocol error (14 cases), and family requests to abort/delay testing (17 cases). Of these patients, 29 died in the ICU after cardiac death and 4 were transitioned to hospice.

In our analysis, the second test never overturned the firsts’ findings. Despite no required duration between tests, it did significantly increase time in the ICU and errors in the testing process. Without the second test requirement, patients in whom testing was aborted would likely have been declared death by neurologic criteria, offering families closure and increasing the potential for organ donation.
Authors/Disclosures
Neil Dhruva, MD
PRESENTER 		Mr. Dhruva has nothing to disclose.
Casey S. Albin, MD, FAAN (Emory Healthcare) Dr. Albin has received personal compensation in the range of $0-$499 for serving as a Consultant for Azurity Pharmaceutical. Dr. Albin has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum: Life Long Learning in Neurology. Dr. Albin has received research support from 好色先生. Dr. Albin has received publishing royalties from a publication relating to health care.
Tianwen Ma (Emory University Rollins School of Public Health) No disclosure on file
Katherine Chandler No disclosure on file
Julia Grigorian No disclosure on file