학술논문
P.051 Do clinical confounders to the neurological examination modify the diagnostic accuracy of CT-angiography for death by neurological criteria/brain death?
Document Type
Article
Author
Source
The Canadian Journal of Neurological Sciences; November 2021, Vol. 48 Issue: Supplement 3 pS33-S33, 1p
Subject
Language
ISSN
03171671
Abstract
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 criteriaTable.Pooled sensitivities and specificities of CT-angiography for death by neurological criteriaAncillary 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)