To diagnose a patient as “brain dead”, health care providers need to be able to perform an assessment that finds no signs of brain activity and no chance that a patient will be taken after life support will get well. Guidelines exist to help patients make these determinations, because patients who are brain dead continue to pulse and feel skin warmer.
Although the JAMA study did not evaluate whether patients were declared brain dead when they actually were not, indicating that the updated guidelines set by the American Academy of Neurology in 2010 have not been consistently made in hospitals. It is possible that health care providers are also practicing up or down for policies, although researchers have not evaluated the results, says Dr. David Greer, a neurologist at Yale University School of Medicine and lead author of the study.
The problem is that without standard policies, hospital workers can cause brain death incorrectly or incorrectly, he says. Although no cases have been reported, the study authors caution. The doctors And hospital administrators should not assume that their policies are working well and no changes are needed.
Of the 492 hospitals evaluated for the study, just over one-third required that a health care provider is Specialization in Neurology Or neurosurgery to determine brain death, and 43 percent determined that an attending physician made a determination. But 150 policies did not mention who should, which means less-experienced doctors can make decisions.
Health care professional performance type of brain death determination
Courtesy JAMA Neurology
About 66 percent of hospitals required two separate examinations to determine brain death and about 21 percent required one exam. In cases where the patient have a heart attack, Specified staff in 29 hospitals have to wait at least 24 hours before determining brain death. When testing for brain death was being considered, policies were required in 201 hospitals to notify them to organ procurement organizations. The longer the patient is brain dead, the more difficult it can be. Donate their organs.
The 2010 The guidelines A study by the American Academy of Neurology researchers conducted about hospital policies in 2008, including 50 US News Best Hospital for Neurology and Neurosurgery were evaluated. Researchers found hospital policies to be quite different, and the new guidelines later created a detailed checklist and step-by-step instructions for determining brain death.
“That study was performed because I noticed that the hospitals I was practicing had different policies,” Greer says. “I thought, ‘How can there be different policies for brain death? They should be the same everywhere.'”
The purpose of Monday’s study is to see whether hospitals have made changes according to the policies set by the American Academy of Neurology. This time the study expanded to all institutions, not just those that US News ranked as high performers. Researchers were able to use the 508 policies of an estimated 650 hospitals with intensive care units, and 492 provided sufficient data to use in the study. Data analyzed were from 26 June 2012 to 1 July 2015.
“The positive finding was that people were updating their hospital policies, but not equally” Greer says. “Perhaps this is a move to the Joint Commission and make it part of the recognition.”
Between protocols for determining brain death, 408 hospitals required doctors to identify the cause of brain dysfunction, and 463 required that healthcare professionals pay attention to the possibility of medications – such as sedatives or Paralysis – should be taken into consideration. In such cases, patients may appear brain dead but may revive later.
When conducting a clinical examination, 441 policies stipulated that a patient should be in a coma, 414 prescribing patients should show no response to pain, 456 prescribing patients show no eye reaction, and 305 prescribing patients do not see any spontaneous respiration while receiving oxygen through the respiratory tract.
Specification of clinical examination requirements
Courtesy JAMA Neurology
To obtain data from hospitals, researchers should not agree to publish information that can identify them, so the study does not identify whether hospitals are clustered by certain geographic regions. The paper states that the data represent hospitals in all 50 states.