In the United States, brain death is exclusively diagnosed in critical care settings, owing to the need for mechanical ventilatory support. With ongoing controversy surrounding the definition of brain death in medical, legal and ethical circles, there is a need to improve public trust in the brain death determination process; part of this involves improving our understanding of the contemporary epidemiology of brain death in children in the US. In this national database study of 15,344 patients who died in pediatric intensive care units (PICUs), data on patient deaths were abstracted to characterize the epidemiology and clinical characteristics of pediatric patients declared brain dead in the US (2012-2017). Researchers found that of those patients who had died, 20.7% had been declared brain dead. The most common causative mechanisms of death included hypoxic-ischemic injury secondary to cardiac arrest (52.7%), shock and/or respiratory arrest without cardiac arrest (12.6%) and traumatic brain injury (20.0%). Patients declared brain dead were more likely than those with cardiovascular death to have sustained trauma (40.5% vs. 11.1%, p<0.001) and more likely to have a higher severity of illness (Pediatric Index of Mortality score) at PICU admission) (p <0 .001). The majority of patients declared to be brain dead did not have a pre-existing neurologic condition (84.4%). The medical length of stay was shortest for patients declared brain dead owing to traumatic brain injury (median 2.0 days, IQR 1.3 to 3.6] days, p<0.001). This study therefore showed that brain death occurred in at least 20% of PICU deaths, with most resulting from acute hypoxic-ischemic or traumatic brain injury. Physician education, standardization of brain death protocols, and the use of precise, consistent language are important to ensure the integrity of brain death determination.
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