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The optimal time between clinical brain death diagnosis and confirmation using CT angiography: a retrospective study
Lionel Kerhuel1, Mohamed Srairi, Gilles Georget
1Department of Anaesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse, 3 Paul Sebatier, Toulouse, France - srairi.m@chu‑toulouse.fr.
Insights
A 12-hour interval after clinical diagnosis may be optimal for computed tomography angiography (CTA) to confirm brain death (BD), reducing inconclusive results. This timing ensures higher accuracy in diagnosing cerebral circulatory arrest.
Area of Science:
- Neurology
- Radiology
- Critical Care Medicine
Background:
- Computed tomography angiography (CTA) is utilized in several countries to confirm brain death (BD).
- A standard six-hour interval between clinical diagnosis and CTA is common, but lacks robust evidence.
- The optimal timing for CTA to confirm BD requires further investigation.
Purpose of the Study:
- To determine the optimal timing for computed tomography angiography (CTA) in the confirmation of brain death (BD).
Main Methods:
- Retrospective observational study of adult patients with clinically diagnosed BD and CTA from January 2009 to December 2013.
- Analysis of 117 CTAs from 104 patients to identify conclusive (BD confirmation) and inconclusive results.
- Evaluation of factors associated with inconclusive CTAs, including timing, decompressive craniectomy, and neurological examination completion.
Main Results:
- CTA confirmed cerebral circulatory arrest in 94 out of 117 cases (80% sensitivity).
- Inconclusive CTAs were performed significantly earlier (2 hours) than conclusive ones (4 hours).
- Conclusive CTA rates increased from 51% at 6 hours to over 80% at 12 hours post-diagnosis.
Conclusions:
- A 12-hour interval following clinical brain death diagnosis may be appropriate.
- This extended interval could minimize the occurrence of inconclusive computed tomography angiography results.
- Optimizing CTA timing enhances diagnostic accuracy for brain death confirmation.
Background:
In several countries, a computed tomography angiography (CTA) is used to confirm brain death (BD). A six‑hour interval is recommended between clinical diagnosis and CTA acquisition despite the lack of strong evidence to support this interval. The aim of this study was to determine the optimal timing for CTA in the confirmation of BD.
Methods:
This retrospective observational study enrolled all adult patients admitted between January 2009 and December 2013 to the intensive care units of a French university hospital with clinically diagnosed BD and at least one CTA performed as a confirmatory test. The CTAs were identified as conclusive (e.g. yielding confirmation of BD) or inconclusive (e.g. showing persistent brain circulation).
Results:
One hundred and four patients (sex ratio M/F 1.8; age 55 years [41‑64]) underwent 117 CTAs. CTAs confirmed cerebral circulatory arrest in 94 cases yielding a sensitivity of 80%. Inconclusive CTAs were performed earlier than conclusive ones (2 hours [1‑3] vs. 4 hours [2‑9], P=0.03) and were associated with decompressive craniectomy (5 cases [23%] vs. 6 cases [7%], P=0.05) and the failure to complete full neurological examination (5 cases [23%] vs. 4 cases [5%], P=0.02). Six hours after BD clinical diagnosis, the proportion of conclusive CTA was only 51%, with progressive increase overtime with more than 80% of conclusive CTA after 12 hours.
Conclusions:
A 12‑hour interval might be appropriate in order to limit the risk of inconclusive CTAs.
