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Diagnostic Accuracy of Transcranial Doppler for Brain Death Confirmation: Systematic Review and Meta-Analysis
J J Chang1, G Tsivgoulis2, A H Katsanos3
1From the Department of Neurology (J.J.C., G.T., M.D.M., A.V.A.), University of Tennessee Health Science Center, Memphis, Tennessee jjwchang@hotmail.com.
AJNR. American Journal of Neuroradiology
|October 31, 2015
Summary
Transcranial Doppler (TCD) is a safe, noninvasive bedside test that accurately confirms brain death by detecting cerebral circulatory arrest. This meta-analysis shows TCD has high sensitivity and specificity for brain death diagnosis.
Area of Science:
- Neurology
- Critical Care Medicine
- Diagnostic Imaging
Background:
- Brain death confirmation is critical in critical care.
- Transcranial Doppler (TCD) is a noninvasive bedside tool for assessing cerebral circulatory arrest.
- Previous studies suggest TCD correlates well with clinical brain death confirmation.
Purpose of the Study:
- To evaluate the diagnostic utility of Transcranial Doppler (TCD) as an ancillary test for brain death confirmation.
- To determine the sensitivity and specificity of TCD in identifying cerebral circulatory arrest.
Main Methods:
- Systematic review of the literature.
- Diagnostic test accuracy meta-analysis comparing TCD to clinical brain death confirmation.
- Inclusion of 22 studies with 1671 patients.
Main Results:
- Pooled sensitivity of TCD for cerebral circulatory arrest was 0.90 (95% CI, 0.87-0.92).
- Pooled specificity of TCD was 0.98 (95% CI, 0.96-0.99).
- High diagnostic accuracy indicated by an area under the curve of 0.964 ± 0.018.
Conclusions:
- Transcranial Doppler (TCD) demonstrates high accuracy as an ancillary test for brain death confirmation.
- TCD evaluates cerebral circulatory arrest, not directly brain stem function, a limitation to consider.
- TCD is a valuable tool in the diagnostic process for brain death.
