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Excerpt
Introduction: Improvements in surgical technique and chronic immunosuppression have made solid organ transplantation feasible and commonplace. Organs for transplantation are harvested from brain dead patients and are in short supply. The ability to define and discuss brain death is germane to modern pediatric practice. Pediatric residencies are failing to effectively teach the concept of brain death to trainees [1]. In this study, we surveyed academic pediatric attendings to evaluate their knowledge of brain death.
Methods: An anonymous, multiple choice questionnaire was administered to full-time pediatric faculty at two accredited training programs in the United States. The attendings defined brain death, interpreted a clinical scenario, stated whether confirmatory testing is legally required to diagnose brain death. Attendings rated their confidence at explaining brain death to a patient's family on a 1 to 5 scale.
Results: Eighty percent (112/140) of questionnaires were completed and returned. Thirty-nine percent (44/112) correctly defined brain death. Fifty-eight percent (65/112) recognized that brain death can be diagnosed without confirmatory testing. Fifty-three percent (59/112) correctly interpreted the clinical scenario. These results were not statistically associated with formal ethics education or training program. All pediatric intensivists (n=12) correctly answered all three questions. Their performance was signicantly better than other pediatricians (neonatologists, neurologists, generalists, and other sub-specialists) (p<.01). Attendings who correctly defined brain death were more confident than those who did not (4.2 +/- 1 vs. 3.1 +/- 0.9, p<0.001). Attendings who correctly interpreted the clinical scenario were more confident than those who did not (3.8 +/- 1.2 vs 3.2 +/- 1.2, p<0.001).
Conclusions: As a whole, academic pediatricians have difficulty defining and applying the concept of brain death. Attending confidence at discussing brain death is associated with improved performance. Resident education regarding brain death should occur during PICU rotations. To prevent dissemination of inaccurate information, clinical discussions involving brain death should be limited to knowledgeable faculty.
