External validation of prediction models for time to death in potential donors after circulatory death.

Predicting time to death in controlled donation after circulatory death (cDCD) donors following withdrawal of life-sustaining treatment (WLST) is important but poses a major challenge. The aim of this study is to determine factors predicting time to circulatory death within 60 minutes after WSLT and validate previously developed prediction models. In a single-center retrospective study, we used the data of 92 potential cDCD donors. Multivariable regression analysis demonstrated that absent cough-, corneal reflex, lower morphine dosage, and midazolam use were significantly associated with death within 60 minutes (area under the curve [AUC] 0.89; 95% confidenence interval [CI] 0.87-0.91). External validation of the logistic regression models of de Groot et al (AUC 0.86; 95% CI 0.77-0.95), Wind et al (AUC 0.62; 95% CI 0.49-0.76), Davila et al (AUC 0.80; 95% CI 0.708-0.901) and the Cox regression model by Suntharalingam et al (Harrell's c-index 0.63), exhibited good discrimination and could fairly identify which patients died within 60 minutes. Previous prediction models did not incorporate the process of WLST. We believe that future studies should also include the process of WLST as an important predictor.

The Influence of End-of-Life Care on Organ Donor Potential.

Many patients with acute devastating brain injury die outside intensive care units and could go unrecognized as potential organ donors. We conducted a prospective observational study in seven hospitals in the Netherlands to define the number of unrecognized potential organ donors outside intensive care units, and to identify the effect that end-of-life care has on organ donor potential. Records of all patients who died between January 2013 and March 2014 were reviewed. Patients were included if they died within 72 h after hospital admission outside the intensive care unit due to devastating brain injury, and fulfilled the criteria for organ donation. Physicians of included patients were interviewed using a standardized questionnaire regarding logistics and medical decisions related to end-of-life care. Of the 5170 patients screened, we found 72 additional potential organ donors outside intensive care units. Initiation of end-of-life care in acute settings and lack of knowledge and experience in organ donation practices outside intensive care units can result in under-recognition of potential donors equivalent to 11-34% of the total pool of organ donors. Collaboration with the intensive care unit and adjusting the end-of-life path in these patients is required to increase the likelihood of organ donation.

[Diagnostic image (387). A man with diminished consciousness after a trepanation]. / Diagnose in beeld (387). Een man met verminderd bewustzijn na een trepanatie.

An 80-year-old man presented with a tension pneumocephalus after burr-hole drainage of a subdural haematoma.

[Diagnostic image (148). A man in coma after a traffic accident. Pneumocephaly]. / Diagnose in beeld (148). Een man in coma na een verkeersongeval. Pneumocefalie.

A 73-year-old man developed extended pneumocephaly due to a skull fracture after a severe traffic accident.

Reading and spelling deficits among children attending a psychiatric day treatment program.

To investigate the specific behavioural and cognitive characteristics which may account for academic deficits in children with psychiatric disorders, 50 children admitted to a day treatment and school program were assessed using behaviour questionnaires for parents and teachers, and tests assessing intelligence (WISC-R), language (CELF-R) and academic performance (Kaufman Test of Educational Achievement). The academic measures Reading Decoding, Reading Comprehension and Spelling formed the dependent variables. Behaviour and cognitive measures which distinguished the sample from normative data constituted the independent variables. Hierarchical multiple regression analyses were performed in order to identify behaviour and cognitive measures accounting for the academic deficits. In the analyses, three measures (Digit Span, Sentence Assembly, Recalling Sentences), probably assessing overlapping cognitive/linguistic functions, accounted for a large proportion of variance for Reading Decoding (0.47), Reading Comprehension (0.63) and Spelling (0.29). None of the behaviour measures accounted for any variance of the academic variables. It is argued that linguistic dysfunction is a primary deficit which underlies problems in academic learning.