Variability in brain death declaration practices in pediatric head trauma patients

The American Academy of Pediatrics' 'Guidelines for the determination of brain death in children' [Pediatrics 1987;80: 298-300] has been cited since its publication as the definitive reference for all cases of pediatric brain death. As these guidelines appear to have been designed for use in patients where the etiology of coma is unclear, they often seem inappropriate in cases of severe head trauma. We questioned whether these guidelines were truly the national standard of practice, particularly in instances of brain death secondary to head trauma. We conducted a survey of pediatric hospitals and pediatric neurosurgeons across the country regarding this matter, and found that their brain death declaration practices varied widely. The majority of hospitals and neurosurgeons in our survey do not follow the guidelines exactly. We feel that these guidelines should be reevaluated and perhaps revised, especially in the setting of severe head trauma.