Policies to determine brain death vary widely from hospital to hospital and there are lapses in the policies, research reveals.
The rules to establish brain death vary widely from on hospital to another, despite the existence of national standards.
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New research has found that the hospital policies to determine brain death are surprisingly inconsistent and do not comply with parameters set by health authorities.
In 2010, the American Academy of Neurology (AAN) wrote a clear and detailed set of guidelines to distinguish a brain-dead patient from one who might emerge from a coma. The purpose was to make judgment 100% accurate and to have complete confidence on whatever call is made.
But researchers have found there are lapses in the policies. Though, there are no legitimate reports of any patient ever being pronounced brain dead when it was not actually true. Still it is necessary to make evaluations with complete certainty.
"That's why we want to provide a very high level of accountability for this, and that's why we created the guidelines to be so specific, so straightforward and cookbook," said David Greer, a neurologist from Yale University and lead author of the study.
"Basically, you might call it 'Brain Death For Dummies.' You should be able to take this checklist to the bedside, follow it point by point and be able to get through it."
To find out how well the guidelines have been adopted, researchers have reviewed the policies of 508 hospitals regarding brain death. These represents a majority of the hospitals in all 50 states that are eligible and equipped to determine brain death in a patient.
But what the researchers found was really astonishing. While most hospital polices have adopted the guidelines, they missed the key parts when they were practically applied.
For instance, more than 20 percent of the policies don't require doctors to check that patients' temperatures are high enough to make the assessment. Almost half of policies don't require doctors to ensure patients' blood pressure is adequate for brain function.
In addition, most of the policies’ do not require a neurologist, neurosurgeon or even a fully trained doctor to declare brain death. In some hospitals nurses or a physician assistant were actually allowed to make the call.
“There are very few things in medicine that should be black and white, but this is certainly one of them,” said Greer.
“The worst-case scenario would be if we were to pronounce somebody brain-dead and then they recovered some neurological function. That would be horrific if that were the case.”
Hospital polices were evaluated with these 5 categories of data: who is qualified to perform the determination of brain death, what are the necessary prerequisites for testing, details of the clinical examination, details of apnea testing, and details of ancillary testing.
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“Hospital policies in the United States for the determination of brain death are still widely variable and not fully congruent with contemporary practice parameters. Hospitals should be encouraged to implement the 2010 AAN guidelines to ensure 100% accurate and appropriate determination of brain death.” Study concludes.