Cornejo-Escatell E, Ruíz-García M

Language: Spanish
References: 13
Page: 2586-266
PDF size: 309.14 Kb.

ABSTRACT

Background: Brain death, involves the irreversible loss of brain stem and cerebral hemispheres functions. The most frequent causes are traumatic, infections, neoplasms and hypoxic.
Objective: To know the clinical epidemiological profile, time to diagnosis, confirmatory studies, imaging results in patients with brain death in a pediatric hospital of tertiary care in Mexico City between January 2005 and January 2017.
Material and Method: Retrospective, retrolective, observational and descriptive study; for which all patients who met diagnostic criteria for brain death in the hospital were included in the period from January 2005 to January 2017. The variables are described: age, sex, etiology, time of diagnosis and paraclinical studies.
Results: 38 patients, mean age of 7.24 years (SD: 5.27), age range: 3 months to 17 years, 21/38 male, most frequent etiologies: neoplasms (34.3%) and infections (28.9%). Average diagnosis time: 3.1 days (SD: 2.7) minimum of 1 and maximum of 6 days. To confirm the diagnosis, electroencephalogram was performed on all patients, a 46% brain scan and 22% stem evoked auditory potentials. Imaging study in 37/38 patients, the most common findings were cerebral edema and intracranial tumor.
Conclusions: Brain death is uncommon in pediatric practice, representing 1.6% of deaths in a tertiary care pediatric institution in Mexico City, which is higher than the 0.9% reported in other series. The time to diagnosis was similar to that reported in the international literature, the etiology was most often secondary to neoplasms because it is an oncological reference center.

REFERENCES

1. Wijdicks EFM, Varelas PN, Gronseth GS, Greer DM; American Academy of Neurology. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010:74(23):1911-18.

2. Mollaret P, Goulon M. Le coma dépassé. Rev Neurol. 1959; 101:3-15.

3. A Definition of Irreversible Coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA. 1968; 205:337-40.

4. Staworn D, et al. Brain death in pediatric intensive care unit patients: incidence, primary diagnosis, and the clinical occurrence of Turner's triad. CritCare Med.1994;22(8):1301- 5.

5. Burns JP, et al. Epidemiology of death in the P1CU at five U.S. teaching hospitals. CritCare Med. 2014;42(9):2101-8.

6. Ley General de Salud en México, publicada el 4 de junio del 2014 en el Diario Oficial de la Federación, en el título XIV, capítulo IV, artículos 343 y 344.

7. Nakagawa TA, Ashwal S, Mathur M, Mysore MR; Society of Critical Care Medicine, Section on Critical Care and Section on Neurology of American Academy of Pediatrics; Child Neurology Society. Clinical report: Guidelines for the determination of brain death in infants and children: an update of the 1987 taskforce recommendations. Pediatrics. 2011;128(3):e720-40.

8. Guidelines for determination of brain death in children. Pediatric Neurology. 1987;3(4):242-43.

9. Paret G, Barzilay Z. Apnea testing in suspected brain-dead children physiological and mathematical modelling. IntensiveCareMed. 1995;21(3):247-52.

10. Alvarez LA, et al. EEG and brain death determination in children. Neurology. 1988;38(2):227-30.

11. Mark M. Stecker, Dragos Sabau, Lucy Sullivan, American Clinical Neurophysiology Society Guideline 6: Minimum Technical Standards for EEG Recording in Suspected Cerebral Death j Clin Neurophysiol. 2016; 33:324-27.

12. Holzman BH, et al. Radionuclide cerebral perfusion scintigraphy in determination of brain death in children. Neurology. 1983;33(8):1027-31.

13. Ruiz-García, et al. M, Brain death in children: clinical, neurophysiological and radioisotopic angiography findings in 125 patients. Childs Nerv Syst. 2000;16(1):40-45.