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Determination of Death by Neurological Criteria in Children and Its Concordance With Ancillary Testing, Primarily
Feyza İnceköy Girgin1, Deniz Birtan2, Cansu Aydin2
1Pediatric Intensive Care Unit, Marmara University Pendik Education and Research Hospital, İstanbul, Türkiye.
Objectives:
Our practice in Türkiye when determining death using neurologic criteria (DNC) is to combine clinical examination and ancillary radiological investigation. We have: 1) examined the diagnostic concordance between clinical examination for DNC and the initial ancillary investigation; 2) evaluated an age cutoff of 24 months in the diagnostic clinical-radiological concordance; and 3) explored age and radiological diagnostic relationships in children with incomplete clinical assessment for DNC.
Design:
Single-center retrospective study, 2012-2025.
Setting:
Academic hospital PICU in İstanbul, Türkiye.
Patients:
We included patients younger than 19 years old in whom DNC was suspected.
Interventions:
None.
Measurements And Main Results:
DNC was suspected in 86 patients. Clinical examination consistent with DNC was completed in 61 patients (mean age, 82.1 mo; 16 < 24 and 45 ≥ 24 mo) with ancillary investigation, which were concordant with DNC either on the first test (77%) or after two or more tests (23%). CT angiography (CTA) was the most used test (80%). The initial CTAs were not consistent with DNC in 23% (95% CI, 13-36%). Based on age grouping (< 24 or ≥ 24 mo), being younger was associated with greater odds of a discordant result (8/16 vs. 6/45; odds ratio, 6.5; 95% CI, 1.77-29.93; p = 0.005). Last, in 15 patients (mean age, 43.6 mo) with suspected DNC, but either incomplete clinical examination (n = 9) or apnea test (n = 6), DNC was finally confirmed using CTA, with five of 15 patients having more than one test.
Conclusions:
In Türkiye, where ancillary investigation is mandatory following a clinical examination consistent with DNC, and where more advanced imaging modalities are unavailable, our practice has been to use CTA. Our 2012-2025 experience of determining DNC shows that CTA is used in the pediatric population, even in children under 2 years old.