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Improving uniformity in brain death determination policies over time

View Article: PubMed Central - PubMed

ABSTRACT

Objective:: To demonstrate that progress has been made in unifying brain death determination guidelines in the last decade by directly comparing the policies of the US News and World Report's top 50 ranked neurologic institutions from 2006 and 2015.

Methods:: We solicited official hospital guidelines in 2015 from these top 50 institutions, generated summary statistics of their criteria as benchmarked against the American Academy of Neurology Practice Parameters (AANPP) and the comparison 2006 cohort in 5 key categories, and statistically compared the 2 cohorts' compliance with the AANPP.

Results:: From 2008 to 2015, hospital policies exhibited significant improvement (p = 0.005) in compliance with official guidelines, particularly with respect to criteria related to apnea testing (p = 0.009) and appropriate ancillary testing (p = 0.0006). However, variability remains in other portions of the policies, both those with specific recommendation from the AANPP (e.g., specifics for ancillary tests) and those without firm guidance (e.g., the level of involvement of neurologists, neurosurgeons, or physicians with education/training specific to brain death in the determination process).

Conclusions:: While the 2010 AANPP update seems to be concordant with progress in achieving greater uniformity in guidelines at the top 50 neurologic institutions, more needs to be done. Whether further interventions come as grassroots initiatives that leverage technological advances in promoting adoption of new guidelines or as top-down regulatory rulings to mandate speedier approval processes, this study shows that solely relying on voluntary updates to professional society guidelines is not enough.

No MeSH data available.


Policies in 2015, similar to 2008, continue to name ancillary tests much more frequently than describing their specific details (e.g., 86% look for EEG as an ancillary test, only 49% stipulate specifics)Radionuclide scintigraphy appears in a notably greater proportion of 2015 policies (88%) than 2008 policies (66%) and with greater details (43% scintigraphy specifics in 2015 vs 21% in 2008). Unproved tests (shaded gray) continue to be endorsed by a minority of policies.
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Figure 5: Policies in 2015, similar to 2008, continue to name ancillary tests much more frequently than describing their specific details (e.g., 86% look for EEG as an ancillary test, only 49% stipulate specifics)Radionuclide scintigraphy appears in a notably greater proportion of 2015 policies (88%) than 2008 policies (66%) and with greater details (43% scintigraphy specifics in 2015 vs 21% in 2008). Unproved tests (shaded gray) continue to be endorsed by a minority of policies.

Mentions: Ancillary testing was optional in a majority of the 2015 institutions (78%), recommended in 12%, and unspecified in 10%. Eighty-four percent indicated specific situations in which ancillary testing would be recommended, most commonly related to an inability to complete the clinical (73%) or apnea (78%) testing, in addition to toxic drug levels (49%), chronic CO2 retention (31%), and normal neuroimaging (6%). A majority of policies specified the use of the 4 AANPP-recommended ancillary tests: EEG (86%), transcranial Doppler (71%), angiography (80%), and radionuclide scintigraphy (88%). Unproven ancillary tests were stipulated in a minority of policies, specifically CT angiography (12%) and somatosensory evoked potentials (10%). In addition, relatively few policies gave specific instructions on how to administer these tests or to interpret results (49% for EEG, 37% for transcranial Doppler, 37% for angiography, and 43% for radionuclide scintigraphy) (figure 5).


Improving uniformity in brain death determination policies over time
Policies in 2015, similar to 2008, continue to name ancillary tests much more frequently than describing their specific details (e.g., 86% look for EEG as an ancillary test, only 49% stipulate specifics)Radionuclide scintigraphy appears in a notably greater proportion of 2015 policies (88%) than 2008 policies (66%) and with greater details (43% scintigraphy specifics in 2015 vs 21% in 2008). Unproved tests (shaded gray) continue to be endorsed by a minority of policies.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5304462&req=5

Figure 5: Policies in 2015, similar to 2008, continue to name ancillary tests much more frequently than describing their specific details (e.g., 86% look for EEG as an ancillary test, only 49% stipulate specifics)Radionuclide scintigraphy appears in a notably greater proportion of 2015 policies (88%) than 2008 policies (66%) and with greater details (43% scintigraphy specifics in 2015 vs 21% in 2008). Unproved tests (shaded gray) continue to be endorsed by a minority of policies.
Mentions: Ancillary testing was optional in a majority of the 2015 institutions (78%), recommended in 12%, and unspecified in 10%. Eighty-four percent indicated specific situations in which ancillary testing would be recommended, most commonly related to an inability to complete the clinical (73%) or apnea (78%) testing, in addition to toxic drug levels (49%), chronic CO2 retention (31%), and normal neuroimaging (6%). A majority of policies specified the use of the 4 AANPP-recommended ancillary tests: EEG (86%), transcranial Doppler (71%), angiography (80%), and radionuclide scintigraphy (88%). Unproven ancillary tests were stipulated in a minority of policies, specifically CT angiography (12%) and somatosensory evoked potentials (10%). In addition, relatively few policies gave specific instructions on how to administer these tests or to interpret results (49% for EEG, 37% for transcranial Doppler, 37% for angiography, and 43% for radionuclide scintigraphy) (figure 5).

View Article: PubMed Central - PubMed

ABSTRACT

Objective:: To demonstrate that progress has been made in unifying brain death determination guidelines in the last decade by directly comparing the policies of the US News and World Report's top 50 ranked neurologic institutions from 2006 and 2015.

Methods:: We solicited official hospital guidelines in 2015 from these top 50 institutions, generated summary statistics of their criteria as benchmarked against the American Academy of Neurology Practice Parameters (AANPP) and the comparison 2006 cohort in 5 key categories, and statistically compared the 2 cohorts' compliance with the AANPP.

Results:: From 2008 to 2015, hospital policies exhibited significant improvement (p = 0.005) in compliance with official guidelines, particularly with respect to criteria related to apnea testing (p = 0.009) and appropriate ancillary testing (p = 0.0006). However, variability remains in other portions of the policies, both those with specific recommendation from the AANPP (e.g., specifics for ancillary tests) and those without firm guidance (e.g., the level of involvement of neurologists, neurosurgeons, or physicians with education/training specific to brain death in the determination process).

Conclusions:: While the 2010 AANPP update seems to be concordant with progress in achieving greater uniformity in guidelines at the top 50 neurologic institutions, more needs to be done. Whether further interventions come as grassroots initiatives that leverage technological advances in promoting adoption of new guidelines or as top-down regulatory rulings to mandate speedier approval processes, this study shows that solely relying on voluntary updates to professional society guidelines is not enough.

No MeSH data available.