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Published on: April 17, 2020
Variability in brain death declaration practices in pediatric head trauma patients
Matthew Y Chang1, Lori A McBride, Margaret A Ferguson
1Department of Neurosurgery, The University of Colorado Health Sciences Center and The Children's Hospital, Denver, USA.
Insights
Pediatric brain death guidelines are not consistently followed nationwide, especially in severe head trauma cases. A survey revealed significant variation in practice, suggesting a need for guideline reevaluation and revision.
Area of Science:
- Pediatric Neurology
- Medical Ethics
- Clinical Practice Guidelines
Background:
- The American Academy of Pediatrics' guidelines for pediatric brain death determination are widely cited.
- These guidelines may be less applicable in cases with clear etiology, such as severe head trauma.
- Concerns exist regarding the universal applicability and adherence to these guidelines.
Purpose of the Study:
- To investigate the adherence to the American Academy of Pediatrics' pediatric brain death guidelines.
- To assess whether these guidelines represent the national standard of practice, particularly in cases of severe head trauma.
- To identify variations in brain death declaration practices among pediatric hospitals and neurosurgeons.
Main Methods:
- A nationwide survey of pediatric hospitals and pediatric neurosurgeons was conducted.
- The survey focused on current practices for declaring brain death, especially in trauma cases.
- Data on adherence to existing guidelines were collected and analyzed.
Main Results:
- Practices for declaring pediatric brain death vary significantly across the country.
- The majority of surveyed hospitals and neurosurgeons do not strictly follow the existing guidelines.
- Discrepancies are particularly noted in cases of severe head trauma.
Conclusions:
- The current pediatric brain death guidelines may not be the definitive national standard in all clinical scenarios.
- There is a need to reevaluate and potentially revise the guidelines, especially for pediatric patients with severe head trauma.
- Clinical practice deviates from the established guidelines, highlighting a gap between policy and practice.
Abstract:
The American Academy of Pediatrics' 'Guidelines for the determination of brain death in children' [Pediatrics 1987;80: 298-300] has been cited since its publication as the definitive reference for all cases of pediatric brain death. As these guidelines appear to have been designed for use in patients where the etiology of coma is unclear, they often seem inappropriate in cases of severe head trauma. We questioned whether these guidelines were truly the national standard of practice, particularly in instances of brain death secondary to head trauma. We conducted a survey of pediatric hospitals and pediatric neurosurgeons across the country regarding this matter, and found that their brain death declaration practices varied widely. The majority of hospitals and neurosurgeons in our survey do not follow the guidelines exactly. We feel that these guidelines should be reevaluated and perhaps revised, especially in the setting of severe head trauma.
