Ganjeifar B, Mehrad-Majd H, Barforooshi AG, Baharvahdat H, Zabihyan S, Moradi A. Diagnostic Value of Computed Tomography Angiography in Confirmation of Brain Death.
World Neurosurg 2023;
178:e275-e281. [PMID:
37467952 DOI:
10.1016/j.wneu.2023.07.042]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND
Accurate and on-time confirmation of brain death (BD) is necessary to prevent unnecessary treatment and allow for well-timed organ harvest for transplantation. Although the clinical criteria for BD are legally reliable in some countries, others might prefer complementary ancillary tests to assess the brain's electrical activity and/or blood circulation. The present study aims to define the sensitivity and specificity of computed tomography angiography using 4-, 7-, and 10-point tests compared with the clinical criteria and electroencephalographic findings in patients with BD.
METHODS
A total of 32 patients with a confirmed diagnosis of BD according to their clinical criteria (cases) and 18 patients with a Glasgow coma scale score of 3 and absent brain stem and papillary reflexes who had spontaneous respiration (controls) were included in the present study. All the patients had blood pressure >90 mm Hg, diuresis >100 mL/hour, and central venous pressure >6-8 mm Hg, and undergone computed tomography angiography (CTA). The 4-, 6-, and 10-point criteria were used to determine the opacity and lack of opacity of the brain vessels in the CTA evaluation scales for the diagnosis of BD.
RESULTS
The 2 groups were homogeneous in terms of age, gender distribution, and coma etiology. All 18 patients in the control group received a score of 0 in the 4-, 7-, and 10-point scores. In contrast, the average values for the 4-, 7-, and 10-point scores for the patients with confirmed BD were 3.75 ± 0.67, 6.4 ± 1.36, and 9.06 ± 2.2, respectively. Of the patients with BD, 28 (87.5%), 26 (81.25%), and 25 (78.12%) received the full score for the 4-point, 7-point, and 10-point tests. The sensitivity, specificity, and negative and positive predictive values for all 3 scores were 100%. Also, the sensitivity for the various cerebral vessels were as follows: internal cerebral vein, 100%; great cerebral vein, 96.9%; posterior 2, 90.6%, middle 4, 87.5%; basilar artery, 84.4%; and anterior 3, 84.4%. Finally, the specificity for the lack of opacification in all these vessels for the diagnosis of BD was 100%.
CONCLUSIONS
According to our findings, the CTA-based 4-point scoring system with 100% specificity can be used with the clinical examination findings to confirm BD.
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