Abstract Details

Title Time to Brain Death/Death by Neurologic Criteria Varies by Etiology

Topic Neuro Trauma and Critical Care

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 19-002

Objective To determine whether the interval between time of initial neurological evaluation and brain death/death by neurologic criteria (BD/DNC) determination differs across major neurologic etiologies.

Background Despite the clinical importance of BD/DNC determination, comparison of time to determination by etiology is understudied, limiting data for counseling families, standardizing practice, and informing possible organ donation. We hypothesized that distinct neurologic causes of catastrophic brain injury differ in their time to BD/DNC determination.

Design/Methods We retrospectively analyzed patients who met criteria for BD/DNC across eight U.S. hospitals between 2012 and 2025. Etiologies were categorized as intracerebral or subarachnoid hemorrhage (ICH/SAH), ischemic stroke, traumatic brain injury (TBI), cardiac arrest, or other (including infectious, neoplastic, or anoxic causes). Time to BD/DNC was defined as the interval from first documented neurological evaluation to formal BD declaration. Median times were compared using the Kruskal–Wallis test, with pairwise comparisons performed using Dunn’s test.

Results Among the 635 patients, ICH/SAH accounted for 248 cases (39.1%), cardiac arrest for 200 (31.5%), TBI for 85 (13.3%), ischemic stroke for 50 (7.8%), and other causes for 52 (8.2%). Median time to BD/DNC differed significantly across etiologies (p<0.001). Cardiac arrest demonstrated the longest median time (68.4 hours, IQR 41.7-96.9), significantly longer than both TBI (43.7 hours, IQR 25.5-72.9, p=0.01) and ICH/SAH (39.4 hours, IQR 23.0-82.6, p<0.001). Ischemic stroke had the second longest median time (64.3 hours, IQR 43.5-158.3), also significantly greater than TBI (p=0.003) and ICH/SAH (p<0.001).

Conclusions These findings suggest that time to BD/DNC varies significantly by underlying etiology. Cardiac arrest and ischemic stroke exhibited notably prolonged intervals compared with traumatic or hemorrhagic causes. These findings suggest that BD/DNC represents not a uniform process, but a spectrum influenced by injury mechanisms, protocols, and systemic factors. Recognizing etiology-specific trajectories may improve the precision of prognostic discussions and optimize coordination of end-of-life care and organ donation.

Authors/Disclosures
Nathaniel A. Gillette PRESENTER	An immediate family member of Mr. Gillette has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for PrognomIQ. An immediate family member of Mr. Gillette has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Molecular and Cellular Proteomics. An immediate family member of Mr. Gillette has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Owen Pickus Law. The institution of an immediate family member of Mr. Gillette has received research support from National Institutes of Health / National Cancer Institute.
Robert Araujo Contreras (Boston Medical Center)	Mr. Araujo Contreras has nothing to disclose.
Rebecca Stafford (Boston Medical Center)	Ms. Stafford has nothing to disclose.
Panayiotis N. Varelas, MD, PhD, FAAN (Albany Med-Department of Neurology)	Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Astra Zeneca -Alexion - Portola. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Annexon. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra Zeneca- Alexion-Portola. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Marinus. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Annexon. Dr. Varelas has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Giammarco, Mullins & Horton P.C. The institution of Dr. Varelas has received research support from Marinus. The institution of Dr. Varelas has received research support from Bayer. Dr. Varelas has received publishing royalties from a publication relating to health care. An immediate family member of Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Rep to the RUC meeting with AAN. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving as a Speaker at the Annual Meeting with AAN. Dr. Varelas has a non-compensated relationship as a President - Past President with Neurocritical Care Society that is relevant to AAN interests or activities.
Rashid A. Ahmed, MD (Upstate University Hospital)	Dr. Ahmed has nothing to disclose.
Joshua A. Kornbluth, MD (Tufts Medical Center)	Dr. Kornbluth has received personal compensation for serving as an employee of Tufts Medical Center. Dr. Kornbluth has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for ERI. Dr. Kornbluth has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for CRICO. The institution of Dr. Kornbluth has received research support from Vivonics, Inc.
Joshua Kahan, MBBS, PhD (New York Presbyterian/ Weill Cornell Medicine)	Dr. Kahan has nothing to disclose.
Sayona John, MD, FAAN (Cook County Health)	Dr. John has nothing to disclose.
Abhijit Lele	Abhijit Lele has received personal compensation for serving as an employee of LifeCenter Northwest .
David M. Greer, MD, FAAN (Boston University School of Medicine)	Dr. Greer 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 Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has a non-compensated relationship as a Treasurer-Elect with American Neurological Association that is relevant to AAN interests or activities. Dr. Greer has a non-compensated relationship as a President with Neurocritical Care Society that is relevant to AAN interests or activities.
Ali Daneshmand, MD (Boston University School of Medicine)	Dr. Daneshmand has nothing to disclose.

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