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Epidemiology of Brain Death in Pediatric Intensive Care Units in the United States
Journal article   Open access   Peer reviewed

Epidemiology of Brain Death in Pediatric Intensive Care Units in the United States

Matthew P Kirschen, Conall Francoeur, Marie Murphy, Danielle Traynor, Bingqing Zhang, Janell L Mensinger, Rebecca Ichord, Alexis Topjian, Robert A Berg, Akira Nishisaki, …
JAMA pediatrics, v 173(5), pp 469-476
01 May 2019
DOI: https://doi.org/10.1001/jamapediatrics.2019.0249
PMID: 30882855
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://jamanetwork.com/journals/jamapediatrics/articlepdf/2728109/jamapediatrics_kirschen_2019_oi_190006.pdfView
Published, Version of Record (VoR) Open
url
https://doi.org/10.1001/jamapediatrics.2019.0249View
Published, Version of Record (VoR) Open

Abstract

Adolescent Brain Death - diagnosis Brain Injuries, Traumatic - mortality Cause of Death Child Child, Preschool Databases, Factual Female Heart Arrest - mortality Hospital Mortality Humans Hypoxia-Ischemia, Brain - mortality Infant Intensive Care Units, Pediatric - statistics & numerical data Length of Stay - statistics & numerical data Male Tissue Donors - statistics & numerical data United States - epidemiology
Guidelines for declaration of brain death in children were revised in 2011 by the Society of Critical Care Medicine, American Academy of Pediatrics, and Child Neurology Society. Despite widespread medical, legal, and ethical acceptance, ongoing controversies exist with regard to the concept of brain death and the procedures for its determination. To determine the epidemiology and clinical characteristics of pediatric patients declared brain dead in the United States. This study involved the abstraction of all patient deaths from the Virtual Pediatric Systems national multicenter database between January 1, 2012, and June 30, 2017. All patients who died in pediatric intensive care units (PICUs) were included. Patient demographics, preillness developmental status, severity of illness, cause of death, PICU medical and physical length of stay, and organ donation status, as well as comparison between patients who were declared brain dead vs those who sustained cardiovascular or cardiopulmonary death. Of the 15 344 patients who died, 3170 (20.7%) were declared brain dead; 1861 of these patients (58.7%) were male, and 1401 (44.2%) were between 2 and 12 years of age. There was a linear association between PICU size and number of patients declared brain dead per year, with an increase of 4.27 patients (95% CI, 3.46-5.08) per 1000-patient increase in discharges (P < .001). The median (interquartile range) of patients declared brain dead per year ranged from 1 (0-3) in smaller PICUs (defined as those with <500 discharges per year) to 10 (7-15) for larger PICUs (those with 2000-4000 discharges per year). The most common causative mechanisms of brain death were hypoxic-ischemic injury owing to cardiac arrest (1672 of 3170 [52.7%]), shock and/or respiratory arrest without cardiac arrest (399 of 3170 [12.6%]), and traumatic brain injury (634 of 3170 [20.0%]). Most patients declared brain dead (681 of 807 [84.4%]) did not have preexisting neurological dysfunction. Patients who were organ donors (1568 of 3144 [49.9%]) remained in the PICU longer after declaration of brain death compared with those who were not donors (median [interquartile range], 29 [6-41] hours vs 4 [1-8] hours; P < .001). Brain death occurred in one-fifth of PICU deaths. Most children declared brain dead had no preexisting neurological dysfunction and had an acute hypoxic-ischemic or traumatic brain injury. Brain death determinations are infrequent, even in large PICUs, emphasizing the importance of ongoing education for medical professionals and standardization of protocols to ensure diagnostic accuracy and consistency.

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47 citations in Web of Science
50 citations in Scopus

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#3 Good Health and Well-Being

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Web of Science research areas
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