P.051 Do clinical confounders to the neurological examination modify the diagnostic accuracy of CT-angiography for death by neurological criteria/brain death?

Abstract

Background: CT-angiography is an ancillary test used to diagnose death by neurological criteria (DNC), notably in cases of unreliable neurological examinations due to clinical confounders. We studied whether clinical confounders to the neurological examination modified CT-angiography diagnostic accuracy. Methods: Systematic review and meta-analysis of studies including deeply comatose patients undergoing DNC ancillary testing. We estimated pooled sensitivities and specificities using a Bayesian hierarchical model, including data on CT-angiography (4-point, 7-point, 10-point scales, and no intracranial flow), and performing a subgroup analysis on clinical confounders to the reference neurological examination. Results: Of 40 studies included in the meta-analysis, 7 involve CT-angiography (n=586). There was no difference between subgroups (Table). The degree of uncertainty involving sensitivity estimates was high in both subgroups. Conclusions: Statistical uncertainty in diagnostic accuracy estimates preclude any conclusion regarding the impact of clinical confounders on CT-angiography diagnostic accuracy. Further research is required to validate CT-angiography as an accurate ancillary test for DNC. Table. Pooled sensitivities and specificities of CT-angiography for death by neurological criteria

An Update on Brain Death/Death by Neurologic Criteria since the World Brain Death Project

“…121 Additionally, in a systematic review and meta-analysis of papers on the diagnostic accuracy of ancillary testing through 2022, Neves Briard et al identified 137 relevant publications and reported similar pooled sensitivities (range of 0.82–0.93) with greater heterogeneity within (σ = 0.10–0.15) than between (σ = 0.04) ancillary test types in patients who met clinical criteria for BD/DNC. 122 They noted unclear or high risk of bias, and emphasized the need for high-quality studies to evaluate ancillary tests.…”