Background Brain death scintigraphy is used to objectively determine futility of care in patients who have sustained irreversible damage to the central nervous system (CNS). The appropriate use of the test and its effectiveness in the clinical setting are not well defined.
Objective To determine for whom and under what circumstances brain death scintigraphy was used within a single institution to better understand how clinicians utilize the study.
Design, Setting, and Participants This is a retrospective observational study of all patients who had brain death studies at a single institution between the dates of March 1999 and December 2002.
Results The charts of 45 patients were reviewed. None of the patients in this study survived. Most patients only lived an average of 2 days. Overall, 17% of the brain death scans revealed perfusion to the brain. Only 18% of the patients did not die on the same day of the brain death study, and of these, all but two were found to have perfusion to the brain. There were no significant differences between the numbers of days to death after a positive versus a negative brain death study.
Conclusions This study examines the use of brain death scintigraphy at a single institution and raises the question as to whether it should be used earlier in the course of hospitalization, if at all, in order to better direct medical resources. Clinicians appear to order brain death scintigraphy on patients who are hopelessly ill and very near death. As it is currently used, the test adds nothing to determine prognosis.
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