G R de Freitas1, C André. 1. Department of Neurology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. gfreitas@ufrj.br
Abstract
OBJECTIVE: The reported sensitivity of transcranial Doppler ultrasonography (TCD) for confirming brain death (BD) ranges from 91% to 100%. We assessed the frequency and causes of false-negative results in TCD examination in a series of patients with BD and in the literature. METHODS: We carried out a prospective TCD examination of consecutive patients with the clinical diagnosis of BD. RESULTS: In 204 (75.5%) of 270 patients, TCD showed a pattern compatible with BD. The causes of the false-negative results were persistent flow in the intracranial arteries in 47 (17.4%) patients and a lack of signal in 19 (7%). Absence of sympathomimetic drug use [odds ratio (OR) 5.4, 95% confidence interval (CI) 1.8-16.0, P = 0.003) and female gender (OR 3.7, 95% CI 1.1-12.5, P = 0.03) were associated with false-negative results. A review of 16 studies showed a sensitivity of 88% and a specificity of 98% of TCD for confirming BD. CONCLUSIONS: The sensitivity of TCD for confirming BD may be lower than previously reported, but is probably similar to that of other non-invasive methods. The specificity of TCD is close to 100%. Uniform criteria are needed for the routine use of TCD as a confirmatory test for BD.
OBJECTIVE: The reported sensitivity of transcranial Doppler ultrasonography (TCD) for confirming brain death (BD) ranges from 91% to 100%. We assessed the frequency and causes of false-negative results in TCD examination in a series of patients with BD and in the literature. METHODS: We carried out a prospective TCD examination of consecutive patients with the clinical diagnosis of BD. RESULTS: In 204 (75.5%) of 270 patients, TCD showed a pattern compatible with BD. The causes of the false-negative results were persistent flow in the intracranial arteries in 47 (17.4%) patients and a lack of signal in 19 (7%). Absence of sympathomimetic drug use [odds ratio (OR) 5.4, 95% confidence interval (CI) 1.8-16.0, P = 0.003) and female gender (OR 3.7, 95% CI 1.1-12.5, P = 0.03) were associated with false-negative results. A review of 16 studies showed a sensitivity of 88% and a specificity of 98% of TCD for confirming BD. CONCLUSIONS: The sensitivity of TCD for confirming BD may be lower than previously reported, but is probably similar to that of other non-invasive methods. The specificity of TCD is close to 100%. Uniform criteria are needed for the routine use of TCD as a confirmatory test for BD.
Authors: E Vicenzini; S Pro; F Randi; P Pulitano; G Spadetta; M Rocco; V Di Piero; G L Lenzi; O Mecarelli Journal: Intensive Care Med Date: 2010-08-06 Impact factor: 17.440
Authors: Stefan Welschehold; Stephan Boor; Katharina Reuland; Frank Thömke; Thomas Kerz; André Reuland; Christian Beyer; Martin Gartenschläger; Wolfgang Wagner; Alf Giese; Wibke Müller-Forell Journal: Dtsch Arztebl Int Date: 2012-09-28 Impact factor: 5.594
Authors: Bradford B Thompson; Linda C Wendell; N Stevenson Potter; Corey Fehnel; Janet Wilterdink; Brian Silver; Karen Furie Journal: Neurocrit Care Date: 2014-12 Impact factor: 3.210