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Impact of the Updated Guideline for Pediatric Brain Death Determination on Current Practice
Conrad Krawiec1, Mohan R Mysore2, Mudit Mathur3
1509393Penn State Children's Hospital, Pediatric Critical Care Medicine, Department of Pediatrics, 500 University Drive, Hershey, PA, USA.
Insights
Pediatric intensivists increasingly find the 2011 brain death guideline useful, reporting improved clarity and consistency in practice. Adherence to the guideline
Area of Science:
- Pediatric Critical Care Medicine
- Neurology
- Medical Ethics
Background:
- A guideline for determining pediatric brain death was updated in 2011.
- The adoption and clinical practice integration of this revised guideline by pediatric intensivists remain unclear.
Purpose of the Study:
- To assess the acceptance and utilization of the 2011 pediatric brain death guideline.
- To evaluate changes in pediatric intensivists' practices and perceptions regarding brain death determination between 2013 and 2020.
Main Methods:
- Surveys administered to US pediatric critical care attending physicians in two distinct periods: July-September 2013 and February-May 2020.
- Assessment of brain death testing practices and the perceived utility of the 2011 guideline.
Main Results:
- A significant increase in the perceived usefulness of the 2011 guideline was observed in 2020 (93.7%) compared to 2013 (83.3%).
- Respondents in 2020 reported greater consistency and clarity in applying the guideline (73.2%) versus 2013 (63.1%).
- No significant deviation from the minimum criteria for determining pediatric brain death was found in clinical practice.
Conclusions:
- The 2011 pediatric brain death guideline has been positively received, enhancing clarity and consistency in clinical practice.
- Pediatric intensivists' application of the guideline aligns with its minimum requirements, ensuring standardized care.
Abstract:
Background: A guideline to determine pediatric brain death was updated in 2011. It is unknown how pediatric intensivists have accepted and adopted the revised guideline into clinical practice. Methods: We surveyed US pediatric critical care attending physicians July 2013 to September 2013 and February 2020 to May 2020. Brain death testing practices and utilization of the 2011 pediatric and neonatal brain death guideline were assessed. Results: The 2020 respondents found that the revised pediatric brain death guideline were useful in clinical practice (93.7% vs 83.3%, P = .0484) and provided more consistency and clarity (73.2% vs 63.1%, P = .0462) when compared to 2013 respondents. Conclusion: This study demonstrates that with defined criteria, survey participants reported increased clarity and consistency. Findings from our study indicate that in clinical practice there is no significant deviation from the minimum requirements to determine brain death in children as outlined in the 2011 guideline.
