@article{ref1,
title="Practice variability in brain death determination: A call to action",
journal="Neurology",
year="2013",
author="Frank, Jeffrey I. and Shappell, Claire N. and Ardelt, Agnieszka and Goldenberg, Fernando and Sanchez, Matthew and Husari, Khalil",
volume="81",
number="23",
pages="2009-2014",
abstract="OBJECTIVE: To characterize the present state of brain death (BD) determination in actual practice relative to contemporary American Academy of Neurology (AAN) guidelines. METHODS: We reviewed the charts of all adult (16 years and older) BD organ donors during 2011 from 68 heterogeneous hospitals in the Midwest United States. Data were collected across 5 categories: guideline performance, preclinical testing, clinical examination, apnea testing, and use of ancillary tests. Practice within categories and overall adherence to AAN guidelines were assessed. RESULTS: Two hundred twenty-six BD organ donors were included. Practice exceeded recommendations in guideline performance but varied widely and deviated from AAN guidelines in all other categories. One hundred two (45.1%) had complete documentation of brainstem areflexia and absent motor response. One hundred sixty-six (73.5%) had completed apnea testing. Of the 60 without completed apnea testing, 56 (93.3%) had ancillary tests consistent with BD. Overall, 101 (44.7%) strictly and 84 (37.2%) loosely adhered to contemporary AAN guidelines. CONCLUSIONS: There is wide variability in the documentation of BD determination, likely reflecting similar variability in practice. This is a call for improved documentation, better uniformity of policies, and comprehensive and strategically targeted educational initiatives to ensure consistently contemporary approaches to BD determination in every patient.<p /> <p>Language: en</p>",
language="en",
issn="0028-3878",
doi="10.1212/01.wnl.0000436938.70528.4a",
url="http://dx.doi.org/10.1212/01.wnl.0000436938.70528.4a"
}