The determination of brain death in coma children with Glasgow coma scale score 3

Abstract

Objective To summarize the clinical features and technical key points on brain death during decision-made process in children with suspected brain death. Methods Twenty-four coma children with Glasgow coma scale score 3 and no spontaneous respiration were collected from May 2015 to February 2017 in Beijing Children′s Hospital, Capital Medical University to make the brain death determination.All children received at least one confirmatory test.According to the Chinese standards for determining brain death (pediatric), all patients were divided into brain death group and non-compliance group.The clinical features were analyzed.The sensitivity, specificity, false positive rate and false negative rate of electroencephalogram (EEG), short latency somatosensory evoked potential (SLSEP) and transcranial Doppler sonography (TCD) were calculated. Results Among these 24 cases, there were 16 males and 8 females, aged 5.6 (2.0, 8.8) years old.Ten cases met the criteria of brain death.Twelve (50%, 12/24 cases) cases received autonomic breathing test.A total of 25 tests were conducted, of which 21 were successful.The completion rates of EEG, TCD and SLSEP were 100.0% (24/24 cases), 83.3% (20/24 cases) and 54.2% (13/24 cases), respectively.EEG had the highest sensitivity (100%) and specificity (79%). SLSEP had good sensitivity (100%), but the specificity was only 40%.The combination of EEG with SLSEP had the highest specificity and sensitivity, both of which were 100%, and the false positive rate and false negative rate were 0. Conclusions The key to determine brain death successfully is to make adequate preparations, to receive formal training and to apply standard operation.In the determination of brain death in children, EEG has a good sensitivity and specificity in single confirmation test, which is the priority item.The combination of EEG with SLSEP is the most advantageous. Key words: Glasgow coma scale; Coma; Child; Brain death