Brain death in pediatric intensive care unit patients: incidence, primary diagnosis, and the clinical occurrence of Turner's triad.

Abstract

To determine the incidence and characteristics of children with brain death in the pediatric intensive care unit (ICU), and to assess the incidence of the clinical triad (Turner's triad) of central diabetes insipidus, low glucose demand, and low CO2 production. Retrospective review of medical records. Two multidisciplinary pediatric ICUs. Medical records of pediatric patients declared brain dead and admitted to two multidisciplinary pediatric ICUs. Patient records were reviewed for demographic data, primary diagnosis, severity of illness (Pediatric Risk of Mortality score and calculated risk of mortality), methods by which brain-death diagnosis was determined, presence of central diabetes insipidus, low glucose demand, low CO2 production in the final 24 hrs before the diagnosis was made, and whether organ donation was accomplished. The incidence of brain death among all patients admitted to the pediatric ICUs was 0.9%, accounting for 11% of patients who died during the same period. The most common presentation leading to brain-death diagnoses was trauma, followed by drowning/near drowning, and meningitis. The majority of brain-death diagnoses were made using both clinical criteria and confirmatory tests (66%). The incidence of clinical signs of Turner's triad was 41% for central diabetes insipidus, 49% for low glucose demand, and 53% for low CO2 production. Two of the three features were present in 38% of patients, and 12% of the patients had all three features. Our series of brain-dead patients in the pediatric ICU showed a 0.9% incidence of brain death. The most common primary diagnosis was trauma, a finding that is similar to other series. We also demonstrated that the clinical triad (Turner's triad) is present in this patient population, although only 12% of study patients demonstrated all three features.