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Minimum Criteria for Brain Death Determination: Consensus Promotion and Chinese Practice

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Abstract

Background

Brain death (BD), the irreversible cessation of function in the whole brain, is a well-known condition in most countries. The criteria and practical guidelines for brain death determination (BDD) in China were issued by the Brain Injury Evaluation Quality Control Center (BQCC) of the National Health and Family Planning Commission in 2013. Thereafter, we proposed a plan called the three-step quality control plan (three-step QCP) to ensure the safety and consistency of the clinical judgments regarding BD. By retrospectively reviewing this plan, we aimed to identify problems during its implementation and to provide suggestions for future work on quality control for BDD.

Methods

Data were retrieved from the BQCC database. The characteristics and test results of physicians undergoing a BDD training course and the BD case records submitted by hospitals before and after receiving accreditation were analyzed.

Results

In the first step of the plan, the error rate for physicians undergoing the BDD paper test was highest for limb movement discrimination (26.29%); this error rate was correlated with age (per 10-year increase) (odds ratio = 1.262, 95% confidence interval 1.067–1.491, P = 0.007) but was nonsignificantly associated with sex, specialty category, professional level, and hospital level (P > 0.05). During the second step of the plan, the highest percentage of problems was associated with apnea testing (22.75%), followed by ancillary testing of BDD (16.17%). In the last step, the highest percentage of problems in the case records was associated with apnea testing (41.73%).

Conclusions

The three-step QCP is of significant utility for ensuring accuracy and appropriateness in BDD. Simultaneously, this study provides important evidence for advancing quality control for BDD in the next stage.

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Authors and Affiliations

  1. Neurointensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China

    Yingying Su, Yan Zhang, Weibi Chen, Fei Tian, Linlin Fan, Gang Liu, Huijin Huang & Junping Wang

  2. Brain Injury Evaluation Quality Control Center of the National Health Commission, Beijing, China

    Yingying Su, Yan Zhang, Weibi Chen, Fei Tian, Linlin Fan, Gang Liu, Huijin Huang & Junping Wang

  3. Brain Injury Evaluation Quality Control Centre of the Provincial Health Commission, Guangzhou, China

    Yongfang Zhang

  4. Brain Injury Evaluation Quality Control Centre of the Provincial Health Commission, Zunyi, China

    Yanjun Deng

Authors
  1. Yingying Su
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  2. Yan Zhang
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  3. Weibi Chen
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  4. Fei Tian
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  5. Linlin Fan
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  6. Gang Liu
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  7. Huijin Huang
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  8. Yongfang Zhang
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  9. Junping Wang
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  10. Yanjun Deng
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Contributions

Conception and design of the study: YS; acquisition of data: YZ, WC, FT, LF, GL, HH, YZ, JW, and YD; analysis and interpretation of data: YS, HH, YZ, JW, and YD; drafting the article or revising it critically for important intellectual content: YS, YZ, WC, FT, LF, and GL; final approval of the version to be submitted: all authors.

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Correspondence to Yingying Su.

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Su, Y., Zhang, Y., Chen, W. et al. Minimum Criteria for Brain Death Determination: Consensus Promotion and Chinese Practice. Neurocrit Care 37, 479–486 (2022). https://doi.org/10.1007/s12028-022-01508-0

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  • DOI: https://doi.org/10.1007/s12028-022-01508-0

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