Validez del Doppler transcraneal en el diagnóstico de muerte encefálica / Validation of transcranial Doppler in the diagnosis of brain death

ABSTRACT

Background: The clinical diagnosis of brain death is complex. Aim: To evaluate the diagnostic accuracy of transcranial Doppler (TCD) for brain death. Patients and Methods: Patients seen on the intensive care unit of a private hospital between January 2004 to December 2008, were included if they were in structural coma, had no craniectomy and had a blind evaluation by a neurologist and TCD done in less than three hours. The diagnosis of brain death was based on a clinical evaluation that considered the absence of sedative drugs, median blood pressure >60 mmHg, body temperature over 35º Celsius and complete absence of brainstem refexes. An expert neurosonologist, with a TCD-PMD-100, 2 Mhz transducer, used an institutional protocol that considers the examination as positive for brain circulatory arrest when there is presence of reverberating, small systolic peaks or the disappearance of a previous signal present on both middle cerebral arteries and intracranial vertebral arteries. Results: Fifty three patients were evaluated, 25 with clinical brain death. On 45 cases (84.9 percent), the interval between both evaluations was less than one hour. The sensitivity, specifcity, positive and negative predictive values for the diagnosis of brain death with TCD were 100, 96, 96.1 and 100 percent respectively. Positive and negative likelihood ratios for brain death were 28 and 0, respectively. Conclusions: TCD is a valid and useful technique for the diagnosis of brain death and can be used on complicated cases.