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P.051 Do clinical confounders to the neurological examination modify the diagnostic accuracy of CT-angiography for death by neurological criteria/brain death?

Published online by Cambridge University Press:  05 January 2022

J Neves Briard ,
R Nitulescu ,
É Lemoine ,
S English ,
L McIntyre ,
G Knoll ,
S Shemie ,
C Martin ,
A Turgeon  and
F Lauzier
...Show all authors
J Neves Briard
Affiliation:
(Montreal)*
R Nitulescu
Affiliation:
(Montreal)
É Lemoine
Affiliation:
(Montreal)
S English
Affiliation:
(Ottawa)
L McIntyre
Affiliation:
(Ottawa)
G Knoll
Affiliation:
(Ottawa)
S Shemie
Affiliation:
(Montreal)
C Martin
Affiliation:
(London)
A Turgeon
Affiliation:
(Québec City)
F Lauzier
Affiliation:
(Québec City)
D Fergusson
Affiliation:
(Ottawa)
M Chassé
Affiliation:
(Montreal)
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Abstract

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Background: CT-angiography is an ancillary test used to diagnose death by neurological criteria (DNC), notably in cases of unreliable neurological examinations due to clinical confounders. We studied whether clinical confounders to the neurological examination modified CT-angiography diagnostic accuracy. Methods: Systematic review and meta-analysis of studies including deeply comatose patients undergoing DNC ancillary testing. We estimated pooled sensitivities and specificities using a Bayesian hierarchical model, including data on CT-angiography (4-point, 7-point, 10-point scales, and no intracranial flow), and performing a subgroup analysis on clinical confounders to the reference neurological examination. Results: Of 40 studies included in the meta-analysis, 7 involve CT-angiography (n=586). There was no difference between subgroups (Table). The degree of uncertainty involving sensitivity estimates was high in both subgroups. Conclusions: Statistical uncertainty in diagnostic accuracy estimates preclude any conclusion regarding the impact of clinical confounders on CT-angiography diagnostic accuracy. Further research is required to validate CT-angiography as an accurate ancillary test for DNC.

Table. Pooled sensitivities and specificities of CT-angiography for death by neurological criteria

Table.

Pooled sensitivities and specificities of CT-angiography for death by neurological criteria

Ancillary test (radiological criteria) [number of patients pooled]Pooled sensitivity (95% highest density interval)Pooled specificity (95% highest density interval)
CT-angiography (4-point scale) [N=303]0.81 (0.57-0.94)1.00 (1.00-1.00)
Clinical confounders (n=197)0.82 (0.62-0.93)1.00 (1.00-1.00)
No clinical confounders (n=106)0.78 (0.25-0.97)1.00 (1.00-1.00)
CT-angiography (7-point scale) [N=79]0.93 (0.63-0.99)1.00 (0.99-1.00)
Clinical confounders (n=79)0.90 (0.64-0.99)1.00 (0.99-1.00)
No clinical confounders (n=0)0.95 (0.27-1.00)1.00 (0.99-1.00)
CT-angiography (10-point scale) [N=54]0.87 (0.34-0.99)1.00 (0.99-1.00)
Clinical confounders (n=54)0.84 (0.37-0.98)1.00 (1.00-1.00)
No clinical confounders (n=0)0.90 (0.03-0.98)1.00 (0.99-1.00)
CT-angiography (no intracranial flow) [N=150]0.89 (0.55-0.98)1.00 (0.99-1.00)
Clinical confounders (n=70)0.90 (0.65-0.98)1.00 (1.00-1.00)
No clinical confounders (n=80)0.93 (0.40-1.00)1.00 (0.99-1.00)

Type
Poster Presentations
Information
Canadian Journal of Neurological Sciences , Volume 48 , Supplement s3: Canadian Neurological Sciences Federation (CNSF) 2021 Congress , November 2021 , pp. S33
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation