TY - JOUR
T1 - Variability in reported physician practices for brain death determination
AU - Braksick, Sherri A.
AU - Robinson, Christopher P.
AU - Gronseth, Gary S.
AU - Hocker, Sara
AU - Wijdicks, Eelco F.M.
AU - Rabinstein, Alejandro A.
N1 - Publisher Copyright:
© 2019 American Academy of Neurology.
PY - 2019/2/26
Y1 - 2019/2/26
N2 - ObjectivesThe degree of training and variability in the clinical brain death examination performed by physicians is not known.MethodsSurveys were distributed to physicians (including physicians-in-training) practicing at 3 separate academic medical centers. Data, including level of practice, training received in completion of a brain death examination, examination components performed, and use of confirmatory tests were collected. Data were evaluated for accuracy in the brain death examination, self-perceived competence in the examination, and indications for confirmatory tests.ResultsOf 225 total respondents, 68 reported completing brain death examinations in practice. Most physicians who complete a brain death examination reported they had received training in how to complete the examination (76.1%). Seventeen respondents (25%) reported doing a brain death examination that is consistent with the current practice guideline. As a part of their brain death assessment, 10.3% of physicians did not report completing an apnea test. Of clinicians who obtain confirmatory tests on an as-needed basis, 28.3% do so if a patient breathes during an apnea test, a clinical finding that is not consistent with brain death.ConclusionsThere is substantial variability in how physicians approach the adult brain death examination, but our survey also identified lack of training in nearly 1 in 4 academic physicians. A formal training course in the principles and proper technique of the brain death examination by physicians with expert knowledge of this clinical assessment is recommended.
AB - ObjectivesThe degree of training and variability in the clinical brain death examination performed by physicians is not known.MethodsSurveys were distributed to physicians (including physicians-in-training) practicing at 3 separate academic medical centers. Data, including level of practice, training received in completion of a brain death examination, examination components performed, and use of confirmatory tests were collected. Data were evaluated for accuracy in the brain death examination, self-perceived competence in the examination, and indications for confirmatory tests.ResultsOf 225 total respondents, 68 reported completing brain death examinations in practice. Most physicians who complete a brain death examination reported they had received training in how to complete the examination (76.1%). Seventeen respondents (25%) reported doing a brain death examination that is consistent with the current practice guideline. As a part of their brain death assessment, 10.3% of physicians did not report completing an apnea test. Of clinicians who obtain confirmatory tests on an as-needed basis, 28.3% do so if a patient breathes during an apnea test, a clinical finding that is not consistent with brain death.ConclusionsThere is substantial variability in how physicians approach the adult brain death examination, but our survey also identified lack of training in nearly 1 in 4 academic physicians. A formal training course in the principles and proper technique of the brain death examination by physicians with expert knowledge of this clinical assessment is recommended.
UR - http://www.scopus.com/inward/record.url?scp=85062169302&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85062169302&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000007009
DO - 10.1212/WNL.0000000000007009
M3 - Article
C2 - 30804063
AN - SCOPUS:85062169302
SN - 0028-3878
VL - 92
SP - E888-E894
JO - Neurology
JF - Neurology
IS - 9
ER -