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J Child Neurol. 2017 Oct;32(12):975-980. doi: 10.1177/0883073817724697. Epub 2017 Aug 22.

Use of Ancillary Tests When Determining Brain Death in Pediatric Patients in the United States.

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1 Division of Neurocritical Care, Departments of Neurology and Neurosurgery, NYU Langone Medical Center, New York, NY, USA.
2 American Academy of Neurology, Minneapolis, MN, USA.
3 Departments of Anesthesiology and Critical Care Medicine, Neurology and Pediatrics, the Children's Hospital of Philadelphia, Philadelphia, PA, USA.


Although pediatric brain death guidelines stipulate when ancillary testing should be used during brain death determination, little is known about the way these recommendations are implemented in clinical practice. We conducted a survey of pediatric intensivists and neurologists in the United States on the use of ancillary testing. Although most respondents noted they only performed an ancillary test if the clinical examination and apnea test could not be completed, 20% of 195 respondents performed an ancillary test for other reasons, including (1) to convince a family that objected to the brain death determination that a patient is truly dead (n = 21), (2) personal preference (n = 14), and (3) institutional requirement (n = 5). Our findings suggest that pediatricians use ancillary tests for a variety of reasons during brain death determination. Medical societies and governmental regulatory bodies must reinforce the need for homogeneity in practice.


ancillary test; brain death; guidelines.; pediatric critical care

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