Sensitivity of transcranial Doppler for confirming brain death: a prospective study of 270 cases

Objective – The reported sensitivity of transcranial Doppler ultrasonography (TCD) for confirming brain death (BD) ranges from 91% to 100%. We assessed the frequency and causes of false‐negative results in TCD examination in a series of patients with BD and in the literature. Methods – We carried out a prospective TCD examination of consecutive patients with the clinical diagnosis of BD. Results – In 204 (75.5%) of 270 patients, TCD showed a pattern compatible with BD. The causes of the false‐negative results were persistent flow in the intracranial arteries in 47 (17.4%) patients and a lack of signal in 19 (7%). Absence of sympathomimetic drug use [odds ratio (OR) 5.4, 95% confidence interval (CI) 1.8–16.0, P = 0.003) and female gender (OR 3.7, 95% CI 1.1–12.5, P = 0.03) were associated with false‐negative results. A review of 16 studies showed a sensitivity of 88% and a specificity of 98% of TCD for confirming BD. Conclusions – The sensitivity of TCD for confirming BD may be lower than previously reported, but is probably similar to that of other non‐invasive methods. The specificity of TCD is close to 100%. Uniform criteria are needed for the routine use of TCD as a confirmatory test for BD.