SynthesisCanadian journal of anaesthesia = Journal canadien d'anesthesie2023
Diagnostic accuracy of ancillary tests for death by neurologic criteria: a systematic review and meta-analysis.
Synthesis in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed.
- Use of transcranial Doppler to determine brain death or death by neurologic criteria in children: a narrative review.World journal of pediatrics : WJP · 2026Review
- Reliability of EEG in brain death diagnosis: an analysis of clinical and technical factors.Frontiers in medicine · 2026Article
- Brain Perfusion Scintigraphy in the Diagnostic Toolbox for the Confirmation of Brain Death: Practical Aspects and Examination Protocol.Diagnostics (Basel, Switzerland) · 2025Article
- New developments in guidelines for brain death/death by neurological criteria.Nature reviews. Neurology · 2024Review
- Ancillary tests for brain death.Frontiers in neurology · 2024Review
- Ancillary testing for neurologic determination of death in adults: in search of a surrogate of clinical function.Intensive care medicine · 2023Article
- Ancillary radionuclide perfusion studies in the determination of death by neurologic criteria: methods, interpretation, and lexicon-a user guide for the clinician.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2023Review
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
purposeAncillary tests are frequently used in death determination by neurologic criteria (DNC), particularly when the clinical neurologic examination is unreliable. Nevertheless, their diagnostic accuracy has not been extensively studied. Our objective was to synthesize the sensitivity and specificity of commonly used ancillary tests for DNC. SOURCE: We performed a systematic review and meta-analysis by searching MEDLINE, EMBASE, Cochrane databases, and CINAHL Ebsco from their inception to 4 February 2022. We selected cohort and case-control studies including patients with 1) clinically diagnosed death by neurologic criteria or 2) clinically suspected death by neurologic criteria who underwent ancillary testing for DNC. We excluded studies without a priori diagnostic criteria and studies conducted solely on pediatric patients. Accepted reference standards were clinical examination, four-vessel conventional angiography, and radionuclide imaging. Data were directly extracted from published reports. We assessed the methodological quality of studies with the QUADAS-2 tool and estimated ancillary test sensitivities and specificities using hierarchical Bayesian models with diffuse priors. PRINCIPAL
findingsOverall, 137 records met the selection criteria. One study (0.7%) had a low risk of bias in all QUADAS-2 domains. Among clinically diagnosed death by neurologic criteria patients (n = 8,891), ancillary tests had similar pooled sensitivities (range, 0.82-0.93). Sensitivity heterogeneity was greater within (σ = 0.10-0.15) than between (σ = 0.04) ancillary test types. Among clinically suspected death by neurologic criteria patients (n = 2,732), pooled ancillary test sensitivities ranged between 0.81 and 1.00 and specificities between 0.87 and 1.00. Most estimates had high statistical uncertainty.
conclusionStudies assessing ancillary test diagnostic accuracy have an unclear or high risk of bias. High-quality studies are required to thoroughly validate ancillary tests for DNC. STUDY REGISTRATION: PROSPERO (CRD42013005907); registered 7 October 2013.
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