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Single institution experience with death by neurological criteria/brain death guideline adherence

  • David P. Lerner
    Correspondence
    Corresponding author at: Neurology Tufts University School of Medicine, Boston, MA 02111, Burlington, MA 01805, United States.
    Affiliations
    Department of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, United States

    Department of Neurology, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, United States
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  • Aleksey Tadevosyan
    Affiliations
    Department of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, United States

    Department of Neurology, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, United States
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  • Brian J. Scott
    Affiliations
    Department of Neurology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 95305, United States
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  • Anil Ramineni
    Affiliations
    Department of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, United States

    Department of Neurology, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, United States
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  • Ribal Bassil
    Affiliations
    Department of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, United States

    Department of Neurology, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, United States
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  • Joseph D. Burns
    Affiliations
    Department of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, United States

    Department of Neurology, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, United States

    Department of Neurosurgery, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, United States
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  • James A. Russell
    Affiliations
    Department of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, United States

    Department of Neurology, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, United States
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      Highlights

      • The use of a checklist improved protocol adherence for diagnosis of death by neurologic criteria/brain death and did not increase time to declaration of death.
      • Metabolic and toxic confounders are common to encounter in patients who progress to death by neurologic criteria/brain death.
      • The clinical diagnosis of death by neurologic criteria/brain death is commonly limited by the inability to complete apnea testing, and these cases require appropriate ancillary testing.

      Abstract

      Objective

      To determine the effect on adherence to an institutional death by neurological criteria/brain death (DNC/BD) policy of implementation of a standardized DNC/BD checklist in the electronic medical record (EMR).

      Methods

      The retrospective study cohort included all patients admitted to our institution who were declared dead by neurologic criteria determined by ICD code (G93.82) between June 2015 and October 2019. Two investigators independently reviewed each case for adherence with institutional policy, and agreement was assessed using unweighted kappa statistics. Patient data and adherence to institutional policy before and after implementation of a standardized DNC/BD checklist were compared.

      Results

      There were 66 patients identified by the initial search and 38 were included in the final analysis, with 19 cases in both the pre- and post- checklist periods. There were no significant differences in age, cause of DNC/BD, time to DNC/BD determination, potential toxic, metabolic, physiologic confounders, or use of ancillary testing. The pre-checklist period adherence was 47.4% (n = 9/19) versus 94.6% (n = 18/19; p = 0.001) in the post-checklist EMR DNC/BD period.

      Conclusion

      Implementation of a standardized EMR checklist substantially improved DNC/BD policy adherence in our institution.

      Classification of Evidence

      This study provides Class IV evidence on the use of standardized EMR checklist to improve death by neurologic criteria/brain death policy adherence.

      Keywords

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