Objective: To early identify the potential organ donors after brain death, a user-friendly and more accurate scale was constructed based on GCS, brainstem reflex and spontaneous respiration assessment.
Methods: From January 1, 2021 to June 31, 2023, neurocritical patients in coma, admitted to the First Affiliated Hospital of SYSU and determined as brain death ultimately were retrospectively included as the retrospective group. Based on existing and previous studies of our center, the factors related to the progression to brain death of such patients were recorded, including GCS, brainstem reflexes, and spontaneous respiratory status. Take the progression to brain death within 14 days after brain injury as interested time. Brain death determination are according to the current criteria for determining brain death in China, and were completed by specialized doctors of our center. In the retrospective group, the relevant factors of the progression to brain death within 14 days were screened, and were utilized to bulid the "GCS-P-R" scale. From July 1, 2023 to January 31, 2024, the comatose neurocritical patients, admitted to the First Affiliated Hospital of SYSU and determined as brain death ultimately, were prospectively included as the prospectively group. In the prospectively group, the the efficacy of constructed "GCS-P-R" scale was verified.
Results: According to the inclusion criteria, 226 case entered the study; 175 cases included in the retrospective group and 51 cases in prospective group. In the retrospective group, statistical analysis showed that GCS=3 (OR=3.86, 95% 1.57-18.21), disappearance of light reflex in unilateral pupil (OR=6.83, 95% 4.35-19.34), and the frequency of spontaneous respiratory less than the set frequency (OR=4.16, 95% 1.63-15.52) were the related factors with the progression to brain death within 14 days after brain injury. Then the "GCS-P-R" scale (P=Pupillary light reflex, R=Respiratory) was built by related factors, and a score≤0 can be used for early identification of potential DBD. In the prospective group, according to the score≤0 of "GCS-P-R "Scale, the probability of progression to brain death within 14 days after brain injury was 92.7%; and better than the performance of GCS≤6.
Conclusions: The "GCS-P-R" scale, which includes pupil light reflex and spontaneous respiratory assessment, can more accurately predict the progression to brain death within 14 days in comatose neurocritical patients , and can be used for early identification of potential organ donors after brain death. The results need to be further validated by external data.