Conrad Krawiec, MD
Penn State Milton S. Hershey Medical Center
Hershey, Pennsylvania
Disclosure information not submitted.
Mohan Mysore, MD, FAAP,FCCM
Professor of Pediatrics
Boys Town National Research Hospital, United States
Disclosure information not submitted.
Mudit Mathur, MBA, MD, FCCM
Associate Professor of Pediatrics and Pediatric Critical Care
Kaiser Fontana Medical Center, United States
Disclosure information not submitted.
Xinying Fang, MS
Graduate Research Assistant
Penn State College of Medicine, United States
Disclosure information not submitted.
Shou Zhou, PhD
Assistant Professor
Penn State College of Medicine, United States
Disclosure information not submitted.
Neal Thomas, MD, FCCM
Professor of Pediatrics
Penn State Children's Hospital, United States
Disclosure information not submitted.
Thomas Nakagawa, MD, FAAP,FCCM
Professor and Medical Director, Pediatric Intensive Care Unit
University of Florida College of Medicine
Jacksonville, Florida
Disclosure information not submitted.
Title: Impact of the Updated Guideline for Pediatric Brain Death Determination on Current Practice
Introduction: 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 their clinical practice. Our objective was to compare pediatric brain death determination (BDD) practices 18 months and 9 years after the implementation of the 2011 guideline and identify physicians’ perceptions, attitudes, barriers, and opportunities for improvement in subsequent guideline revisions.
Methods: We surveyed attending pediatric critical care physicians July 2013 to September 2013 and February 2020 to May 2020 within the United States. Brain death testing practices and utilization of the 2011 pediatric and neonatal brain death guideline were assessed.
Results: The 2020 survey revealed that a majority of respondents found that the revised pediatric brain death guideline were useful in clinical practice (93.7% versus 83.3%, p=0.05) and provided more consistency and clarity (73.2% versus 63.1%, p=0.05) when compared to 2013 respondents. Survey responses regarding reports of inaccurate determination of brain death or diagnostic error decreased in the 2020 survey [44 (18.6%) in 2013 versus 7 (4.9%) in 2020] (p< 0.001).
Conclusions: Prior to the implementation of the revised 2011 guideline, pediatric BDD had been variable. This study demonstrates that with defined criteria and the use of a standardized checklist, survey participants reported increased clarity and consistency as well as fewer cases of inaccurate pediatric BDD. 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.