Implementation of CT perfusion as The Ancillary Test of Choice for Neurological Determination of Death: A Qualitative Approach
Reva Trivedi, Beili Huang, Robert Green, Jai Shankar
Background: Accurate neurological determination of death (NDD) is essential in healthcare and often
requires several ancillary tests in patients with an ambiguous clinical examination or confounding
factors. In the absence of a widely accepted ideal in terms of ancillary tests, this study aims to establish
computed tomography perfusion (CTP) as the gold standard test to minimize variability in practice
guidelines.
Methods: After approval from the institutional research ethics board, the study was conducted in 3
phases: In the first phase of six months, barriers, facilitators, and general attitudes towards CTP were
identified among neuroradiologists and critical care physicians, and tailored strategies were developed.
After the protocol’s implementation for twelve months in phase 2, final evaluations of strategies were
conducted in phase 3 for six months. Family members were also interviewed to discuss their views on
NDD and CTP’s role in the decision.
Results: Discussions with neuroradiologists and critical care physicians uncovered a general sense of
unfamiliarity with CTP, citing the technology’s novelty. However, these feelings of unfamiliarity were
found to have reduced after the modality’s implementation for a year. The family members also expressed
their desire for certainty regarding NDD and a test with decisive results.
Conclusion: With continued open discussions and dedicated education to its adopters, this study
indicates CTP to be a promising ideal ancillary test for NDD in the future.
