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Evidence summaries

Computed Tomography (CT) Angiography for Confirmation of the Clinical Diagnosis of Brain Death

When diagnosing brain death, computed tomography (CT) angiography may be useful as a confirmatory or add-on test following a clinical diagnosis, but should probably not become a mandatory or routine confirmatory test. Level of evidence: "C"

Summary

A Cochrane review [Abstract] 1 included 10 studies with a total of 366 subjects. Eight studies (n=377) were included in the as-published data analysis. In all studies patients underwent the reference standard (clinical testing for brain death) prior to undergoing the index test computed tomography angiography (CTA). All but one studies reported CTA investigation in patients already declared clinically brain dead. Results demonstrated a sensitivity estimate of 0.84 (95% CI 0.69 to 0.93; 8 studies, n=337). The 95% approximate prediction interval was very wide (0.34 to 0.98). Data in 3 studies (314 events) were available as a four-vessel interpretation model and the data could be re-analysed to a four-vessel interpretation model in further 5 studies. Results demonstrated a similar sensitivity estimate of 0.85 (95% CI 0.77 to 0.91; 8 studies, n=314) but with an improved 95% approximate prediction interval (0.56 to 0.96).

Comment: The quality of the evidence is downgraded by inconsistency (heterogeneity in diagnostic criteria with CTA) and imprecise results (few patients).

Clinical comments

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    References

    • Taylor T, Dineen RA, Gardiner DC et al. Computed tomography (CT) angiography for confirmation of the clinical diagnosis of brain death. Cochrane Database Syst Rev 2014;3():CD009694. [PubMed]

Primary/Secondary Keywords