Sensitivity of transcranial Doppler for confirming brain death: a prospective study of 270 cases

Acta Neurol Scand. 2006 Jun;113(6):426-32. doi: 10.1111/j.1600-0404.2006.00645.x.

Abstract

Objective: The reported sensitivity of transcranial Doppler ultrasonography (TCD) for confirming brain death (BD) ranges from 91% to 100%. We assessed the frequency and causes of false-negative results in TCD examination in a series of patients with BD and in the literature.

Methods: We carried out a prospective TCD examination of consecutive patients with the clinical diagnosis of BD.

Results: In 204 (75.5%) of 270 patients, TCD showed a pattern compatible with BD. The causes of the false-negative results were persistent flow in the intracranial arteries in 47 (17.4%) patients and a lack of signal in 19 (7%). Absence of sympathomimetic drug use [odds ratio (OR) 5.4, 95% confidence interval (CI) 1.8-16.0, P = 0.003) and female gender (OR 3.7, 95% CI 1.1-12.5, P = 0.03) were associated with false-negative results. A review of 16 studies showed a sensitivity of 88% and a specificity of 98% of TCD for confirming BD.

Conclusions: The sensitivity of TCD for confirming BD may be lower than previously reported, but is probably similar to that of other non-invasive methods. The specificity of TCD is close to 100%. Uniform criteria are needed for the routine use of TCD as a confirmatory test for BD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Brain / blood supply
  • Brain / physiopathology*
  • Brain Death / diagnostic imaging*
  • Brain Death / physiopathology
  • Cerebral Arteries / diagnostic imaging
  • Cerebral Arteries / physiopathology
  • Cerebrovascular Circulation / physiology
  • False Negative Reactions
  • Female
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic
  • Neurosurgical Procedures
  • Predictive Value of Tests
  • Prospective Studies
  • Sensitivity and Specificity
  • Sex Factors
  • Skull Fractures / complications
  • Sympathomimetics / pharmacology
  • Ultrasonography, Doppler, Transcranial / methods*

Substances

  • Sympathomimetics