Evaluation of Computed Tomography Angiography as an Ancillary Test to Reduce Confusion After Clinical Diagnosis of Brain Death

Abstract

BackgroundThe diagnosis of brain death (BD) is mainly a clinical diagnosis. Ancillary tests may be used in confusing situations. Although computed tomography angiography (CTA) has high sensitivity and specificity, it can give false-positive results in cases with craniotomy. ObjectiveThe aim of this study is to emphasize the importance of accurate and detailed clinical diagnosis and to reveal that there is organ loss as a result of prolonged supportive tests, especially in developing countries. Material and MethodsThis retrospective study included patients who were diagnosed with BD in the intensive care unit of Van Yüzüncü Yıl University, between September 2014 and August 2017 in Turkey. The study included 14 male and 8 female patients. Patients who did not show any spontaneous respiratory symptoms after the apnea test were diagnosed with clinical BD. Patients on neurodepressant medications who were hypothermic or hypoxic or had a severe endocrine or metabolic disorder were excluded from the study. CTA was used as an ancillary test in compliance with legal requirements. Age, sex, hospitalization days, day of clinical diagnosis of BD, first radiologic evaluation by CTA, clinical diagnosis, and radiologic evaluation were recorded for all patients. ResultsRadiologic evaluation was not compatible with the clinical evaluation in 5 patients. Although 2 of these 5 patients had BD diagnosis clinically, blood flow could be expected during CTA because of cranial injury. Unlike in the literature, false positivity was found in 3 patients with hypoxic ischemic encephalopathy in the present study. ConclusionsProper management of limited resources and the facilitation of cadaver organ donation in developing countries are important and humanitarian global responsibilities. Revision of the country’s legal regulations is important and is warranted in this regard.