Diagnosis of Death Using Neurological Criteria in Children: The U.K. Experience, 2015-2023.

Abstract

Objectives: In the United Kingdom, the starting point for diagnosing and confirming death using neurologic criteria (DNC) is when death is suspected to have occurred following devastating brain injury in patients on an ICU who remain deeply comatose, have absent brainstem reflexes and are apneic with their lungs mechanically ventilated but in whom circulation and other bodily functions persist. In this report, we describe the U.K. experience of diagnosing DNC in children.

Design: Retrospective review of data collected by the U.K. National Health Service Blood and Transplant Potential Donor Audit.

Setting and patients: U.K. children from birth to younger than 18 years old with suspected DNC between April 1, 2015, and April 1, 2023.

Interventions: None.

Measurements and main results: A total of 824 children were suspected of DNC and 565 of 824 (68.6%) proceeded to have testing. Overall, 393 of 565 (69.5%) of the tested patients were cared for on a PICU, 164 of 565 (29%) on an adult ICU, three of 565 (0.5%) on a neonatal ICU, and the other five of 565 (1%) in other locations. After testing, 548 of 565 (97%) were confirmed as having died using neurologic criteria. During 2020 to 2023, we estimate that DNC occurred in 6.2% of all PICU deaths. Of 393 of 565 children undergoing testing on the PICU, 15 were younger than 2 months, 45 between 2 months to 1 year, and 31 between 1 and 2 years.

Conclusions: During the 8 years, 2015-2023, out of 824 children younger than 18 years old suspected of being dead using neurologic criteria, close to one-in-three did not proceed to formal testing. In 2020-2023, DNC in U.K. PICUs accounted for 6.2% of all death. Last, in young children up to 2 years old, the average experience of diagnosing and confirming DNC across each of the 30 U.K. PICUs was one patient every other year.