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Brain Death Confirmation: Comparison of Computed Tomographic Angiography With Nuclear Medicine Perfusion Scan

Berenguer, Christina M. MD; Davis, Frank E. MD, FACS; Howington, Jay U. MD

The Journal of Trauma: Injury, Infection, and Critical Care: March 2010 - Volume 68 - Issue 3 - p 553-559
doi: 10.1097/TA.0b013e3181cef18a
Original Article

Introduction: Brain death is a difficult diagnosis to make, relying primarily on clinical examination. Ancillary tests are used when confounders exist. Nuclear medicine perfusion test (NMPT) is currently the preferred test for confirming brain death. Computed tomographic angiography (CTA) may be an alternative test to confirm brain death. It is readily available 24 hours a day at most level I trauma centers and is easy to perform.

Methods: Patients with a clinical examination consistent with brain death were selected from the intensive care unit at a 550-bed teaching hospital. The patients underwent NMPT followed immediately by CTA. Both studies were read by radiologists blinded to the results of the alternative study. Absence of brain perfusion confirmed brain death. Multiple independent variables were collected on each patient including demographics, core body temperature, apnea challenge, mechanism of injury, timelines, renal function pre- and posttesting, organ donation, and time to procurement.

Results: There were 25 patients enrolled in the study with multiple injury patterns. No false negative exams were identified on CTA when compared with NMPT. Three patients without flow on NMPT showed minimal flow on CTA. Each of these had open skull defects. Sensitivity of CTA was 0.86 and specificity was 1. There was no induced morbidity with regards to renal failure and organ donation.

Conclusion: CTA is a quick and efficient test for brain death confirmation. CTA demonstrated no false negative studies. The resolution of CTA seems to have an increased sensitivity for cerebral blood flow. Further studies with larger sample sizes need to be performed.

From the Memorial University Medical Center (C.M.B., F.E.D.), Savannah, Georgia; Mercer University School of Medicine (F.E.D.), Savannah, Georgia; and the Neurological Institute of Savannah (J.U.H.), Savannah, Georgia.

Submitted for publication January 25, 2009.

Accepted for publication November 6, 2009.

Presented at American College of Surgeons Committee on Trauma Resident Paper Competition for State level (Georgia) and American College of Surgeons Committee on Trauma Resident Paper Competition for Regional Level (Region 4), and the 22nd Annual Meeting of the Eastern Association for the Surgery of Trauma, January 13–17, 2009, Lake Buena Vista, Florida.

Address for Reprints: Christina M. Berenguer, MD, Department of Surgery, Memorial University Medical Center, 4700 Waters Avenue, Savannah, GA 31404; email: cmberen@hotmail.com, berench1@memorialhealth.com.

© 2010 Lippincott Williams & Wilkins, Inc.