• Nicole K McKinnon, Christina Maratta, Lionel S Zuckier, J Gordon Boyd, Michaël Chassé, Laura Hornby, Andreas Kramer, Julie Kromm, Owen T Mooney, Prakash Muthusami, Roy Nitulescu, Jaewoo Park, Marat Slessarev, and John Basmaji.
• Department of Critical Care, The Hospital for Sick Children (SickKids), 555 University Avenue, Toronto, ON, M5G 1X8, Canada. nicole.mckinnon@sickkids.ca.
• Can J Anaesth. 2023 Apr 1; 70 (4): 749770749-770.

PurposeWe performed a systematic review and meta-analysis to determine the diagnostic test accuracy of ancillary investigations for declaration of death by neurologic criteria (DNC) in infants and children.SourceWe searched MEDLINE, EMBASE, Web of Science, and Cochrane databases from their inception to June 2021 for relevant randomized controlled trials, observational studies, and abstracts published in the last three years. We identified relevant studies using Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology and a two-stage review. We assessed the risk of bias using the QUADAS-2 tool, and applied Grading of Recommendations Assessment, Development, and Evaluation methodology to determine the certainty of evidence. A fixed-effects model was used to meta-analyze pooled sensitivity and specificity data for each ancillary investigation with at least two studies.Principal FindingsThirty-nine eligible manuscripts assessing 18 unique ancillary investigations (n = 866) were identified. The sensitivity and specificity ranged from 0.00 to 1.00 and 0.50 to 1.00, respectively. The quality of evidence was low to very low for all ancillary investigations, with the exception of radionuclide dynamic flow studies for which it was graded as moderate. Radionuclide scintigraphy using the lipophilic radiopharmaceutical 99mTc-hexamethylpropyleneamine oxime (HMPAO) with or without tomographic imaging were the most accurate ancillary investigations with a combined sensitivity of 0.99 (95% highest density interval [HDI], 0.89 to 1.00) and specificity of 0.97 (95% HDI, 0.65 to 1.00).ConclusionThe ancillary investigation for DNC in infants and children with the greatest accuracy appears to be radionuclide scintigraphy using HMPAO with or without tomographic imaging; however, the certainty of the evidence is low. Nonimaging modalities performed at the bedside require further investigation.Study RegistrationPROSPERO (CRD42021278788); registered 16 October 2021.© 2023. The Author(s).

10 keywords...

hide…