Sensitivity of transcranial Doppler for confirming brain death: a prospective study of 270 cases

Authors: de Freitas, G. R.; André, C.

Source: Acta Neurologica Scandinavica, Volume 113, Number 6, June 2006 , pp. 426-432(7)

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Abstract:

de Freitas GR, André C. Sensitivity of transcranial Doppler for confirming brain death: a prospective study of 270 cases. Acta Neurol Scand 2006: 113: 426–432.

The reported sensitivity of transcranial Doppler ultrasonography (TCD) for confirming brain death (BD) ranges from 91% to 100%. We assessed the frequency and causes of false-negative results in TCD examination in a series of patients with BD and in the literature. Methods –

We carried out a prospective TCD examination of consecutive patients with the clinical diagnosis of BD. Results –

In 204 (75.5%) of 270 patients, TCD showed a pattern compatible with BD. The causes of the false-negative results were persistent flow in the intracranial arteries in 47 (17.4%) patients and a lack of signal in 19 (7%). Absence of sympathomimetic drug use [odds ratio (OR) 5.4, 95% confidence interval (CI) 1.8–16.0, P = 0.003) and female gender (OR 3.7, 95% CI 1.1–12.5, P = 0.03) were associated with false-negative results. A review of 16 studies showed a sensitivity of 88% and a specificity of 98% of TCD for confirming BD. Conclusions –

The sensitivity of TCD for confirming BD may be lower than previously reported, but is probably similar to that of other non-invasive methods. The specificity of TCD is close to 100%. Uniform criteria are needed for the routine use of TCD as a confirmatory test for BD.

Keywords: brain death; diagnosis; transcranial Doppler; ultrasonography

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1600-0404.2006.00645.x

Publication date: 2006-06-01