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