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Abstract Details

Isolated Brainstem Death is Rare and is Associated with Infratentorial Stroke Among Patients Suspected of Death by Neurologic Criteria
Neuro Trauma and Critical Care
P1 - Poster Session 1 (8:00 AM-9:00 AM)
IBD occurs in patients who have a clinical examination consistent with death by neurologic criteria (DNC), but in whom there is ancillary test evidence of preserved supratentorial perfusion and absent infratentorial perfusion. There are currently no documented risk factors for IBD.
Our objective was to investigate the association between infratentorial stroke and isolated brainstem death (IBD) among patients suspected of neurologic death.
This was an analysis of the INDex trial, a 15-site prospective diagnostic accuracy study that enrolled adult patients admitted to the intensive care unit after a severe brain injury who were deeply comatose despite the absence of sedation. We identified patients with infratentorial ischemic or hemorrhagic stroke using non-contrast CT scans. Patients underwent consecutive clinical examination for DNC and a brain CT-perfusion scan. IBD was diagnosed in patients with (1) a clinical examination consistent with DNC, and (2) preserved supratentorial perfusion despite absent infratentorial perfusion on the CT-perfusion scan. We estimated the association between infratentorial stroke and IBD using a generalized linear mixed model with a logit link function and intercept random effects for participating site, while adjusting for relevant pre-specified covariables using inverse probability weighting based on a propensity score. We also calculated the predictive values of infratentorial stroke for IBD.
Among 274 included patients, the median [IQR] age was 60.0 [47.0-69.0] years, 130 (47%) were female, and 30 (11%) had an infratentorial stroke. The prevalence of IBD was 1.8% (95% CI: 0.6-4.2%). Infratentorial stroke was associated with IBD (aOR: 16.81, 95% CI: 3.95-71.51). The positive predictive value of infratentorial stroke for IBD was 10.0% (95% CI: 3.5-25.6%), whereas its negative predictive value was 99.2% (95% CI: 97.1-99.8%).
Infratentorial stroke is associated with IBD among patients suspected of DNC. In the absence of infratentorial stroke, the probability of IBD in this population is very low.
Joel Neves Briard, MD (Universite De Montreal)
Dr. Neves Briard has received research support from American Academy of Neurology.
Dean Fergusson (Ottawa Hospital) Dean Fergusson has nothing to disclose.
Shane English (The Ottawa Hospital) Shane English has nothing to disclose.
Sonny Dhanani, MD (CHEO) The institution of Dr. Dhanani has received research support from Health Canada.
Alexis Turgeon Alexis Turgeon has nothing to disclose.
Francois Lauzier (CHU de Quebec-Universite Laval) Francois Lauzier has nothing to disclose.
Ian Ball, MD Dr. Ball has nothing to disclose.
Jai Jai Shankar Jai Jai Shankar has nothing to disclose.
Michael Chasse Michael Chasse has nothing to disclose.