Accuracy of Power Mode Transcranial Doppler in the Diagnosis of Brain Death

Background: The diagnosis of brain death (BD) is complex. For this reason, we aimed to evaluate the accuracy of power mode transcranial Doppler (PMD-TCD) in diagnosing BD.Patients and methods: Patients admitted to an intensive care unit between December 2003 and January 2012 were included in this study if they were in a structural coma, had no craniectomy, and were evaluated blind by a neurologist using PMD-TCD. The diagnosis of BD was based on an evaluation that took into consideration the absence of sedative drugs, a median blood pressure > 60 mmHg, a body temperature > 35 degrees C, and the absence of brainstem reflexes. A neurosonologist followed a protocol using PMD-TCD that considered the examination as positive for brain circulatory arrest given the presence of reverberating, small systolic peaks or the disappearance of a previous signal present in both middle cerebral arteries and intracranial vertebral arteries.Results: A total of 74 patients were evaluated. In 61 (82.4%) patients the interval between both evaluations was less than 1 hour. The sensitivity and specificity for the diagnosis of BD with PMD-TCD were 100% and 98%, respectively. The positive and negative likelihood ratios for BD were 45 and 0, respectively. Conclusion: PMD-TCD is accurate for the diagnosis of BD. (C) 2014, Elsevier Taiwan LLC and the Chinese Taipei Society of Ultrasound in Medicine.