Open AccessPrediction of evolution toward brain death upon admission to ICU in comatose patients with spontaneous intracerebral hemorrhage using simple signs
Author(s) -
Galbois Arnaud,
Boëlle PierreYves,
Hainque Elodie,
Raynal Marianne,
Cazejust Julien,
Baudel JeanLuc,
AitOufella Hafid,
Alves Mikael,
Bigé Naïke,
Maury Eric,
Guidet Bertrand,
Offenstadt Georges
Publication year - 2013
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12084
Subject(s) - medicine , intensive care unit , pupillary light reflex , coma (optics) , intracerebral hemorrhage , mechanical ventilation , glasgow coma scale , reflex , anesthesia , odds ratio , neurointensive care , spontaneous intracerebral hemorrhage , logistic regression , organ donation , transplantation , pupil , neuroscience , biology , physics , optics
Summary The aim of the study was to identify the predictors of brain death ( BD ) upon admission to the intensive care unit ( ICU ) of comatose patients with spontaneous intracerebral hemorrhage ( ICH ). Patients admitted in our ICU from 2002 to 2010 for spontaneous ICH and placed under mechanical ventilation were retrospectively analyzed. Of the 72 patients, 49% evolved to BD , 39% died after withdrawal of life support, and 12% were discharged alive. The most discriminating characteristics to predict BD were included in two models; Model 1 contained ≥3 abolished brainstem responses [adjusted odds ratios ( OR ) = 8.4 (2.4, 29.1)] and the swirl sign on the baseline CT ‐scan [adjusted OR = 5.0 (1.6, 15.9)] and Model 2 addressed the abolition of corneal reflexes [unilateral/bilateral: adjusted OR = 4.2 (0.9, 20.1)/8.8 (2.4, 32.3)] and the swirl sign on the baseline CT ‐scan [adjusted OR = 6.2 (1.9, 20.0)]. Two scores predicting BD were created (sensitivity: 0.89 and 0.88, specificity: 0.68 and 0.65). Risk of evolution toward BD was classified as low (corneal reflexes present and no swirl sign), high (≥1 corneal reflexes abolished and swirl sign), and intermediate. Simple signs at ICU admission can predict BD in comatose patients with ICH and could increase the potential for organ donation.