[Computed tomography as a tool to detect potential brain-dead donors]

Abstract

Background and objective: To assess the ability of urgent head computed tomography (CT) scan screening to detect patients who can evolve to brain death (BD).

Patients and method: Patients who underwent urgent head CT scan and meet the following criteria: midline shift greater than 5mm and/or decrease or absence of basal cisterns. A follow-up for 28 days of each patient was made. Epidemiological data (sex, age, cause of brain injury), clinical data (level of consciousness, severity index in the CT) and patient outcomes (death, BD, discharge or transfer) were recorded. This was a prospective observational study.

Results: One hundred and sixty-six patients were selected for study, with mean age 60.08 (SD 21.8) years. A percentage of 49.4 were men and the rest women. In the follow-up, 20,5% (n=34) had BD. In univariate analysis, intracerebral hemorrhage, Glasgow Coma Scale score less than 8 and alteration of basal cisterns were statistically significant in predicting BD (P<.05). Multivariate analysis showed that patients with compression of basal cisterns were 20 (95% confidence interval [95% CI] 2.61 to 153.78; P=.004] times more likely to progress to brain death, while the absence there of 62.6 (95% CI 13.1 to 738.8; P<.001] times more.

Conclusions: Our work shows that data as easy to interpret as compression/absence of basal cisterns can be a powerful tool for screening patients at risk for progression to BD.

Keywords: Brain death; Donación; Donation; Head computed tomography scan; Muerte encefálica; Tomografía computarizada de cráneo.