144th Annual Meeting of the American Neurological Association - ANA 2019, Saint Louis (United States of America). 13-15 octubre 2019
Summary:
Background:
Brain death determination requires expertise and in some cases leads to additional medical procedures that may not be available everywhere. It also generates a great amount of distress for patients and their families. Cases such as that of Terri Schiavo who spent years on a feeding tube due to the lack of a firm diagnosis exemplify the need for a better process. We studied the legal and ethics aspects of the use of teleneurology to help diagnose brain death.
Discussion:
The Uniform Determination of Death Act (UDDA) has defined brain death clinically as “the irreversible cessation of all functions of the entire brain, including the brain stem, as a valid criterion for death.” Brain death is diagnosed clinically following guidelines developed by the American Academy of Neurology (AAN) that include absence of brain stem reflexes, presence of apnea, and a no responsiveness state - information that can potentially be evaluated by an onsite medical professional and then evaluated by a remote neurologist. Major benefits of the use of telemedicine include the opportunity for an accurate diagnosis from the opinions of multiple neurologists and the time and costs saved from the unnecessary utilization of intensive care resources once a patient has been diagnosed as brain dead. This would be especially useful in urban underserved areas or rural communities where the demand for neurologists greatly exceeds the number of patients suffering from serious neurological diseases and disorders. The CHRONIC Care Act, which became law on Feb. 9, 2018 as a part of the Bipartisan Budget Act of 2018, has been a step forward in the use of telemedicine-based assessments for neurologic disorders. Recent information shows that this approach for stroke assessments has been deemed reliable and is widely accepted. Challenges: A major challenge to creating a central 24/7 available neurologist center is that doctors present in this center may not be licensed to practice in the state that the patient they are evaluating is residing in. Also ethical reviews needs to be conducted and ICU team needs proper training on key aspects of the neurologic exam. Another challenge is to adjust the national policy level.
Conclusion:
The advancement of technology and its growing integration into healthcare systems for clinical decision making serve as a prime opportunity to develop telemedicinebased assessments that would enhance brain death diagnosis.
Publication date: October 2019.
Citation:
Gupta, A., Schwamm, L.H., Girkar, U.M., Palacios, R., Singla, P., May, H., Matiello, M., Enhanced brain death diagnosis through teleneurology, 144th Annual Meeting of the American Neurological Association - ANA 2019, Saint Louis (United States of America). 13-15 October 2019.
IIT-19-164A_abstract
