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Clinicians diagnose death by neurological criteria (DNC) when brain function is lost completely after devastating neurological injury. Because the stakes are so substantial, this diagnosis must be accurate. We typically diagnose DNC by protocolized clinical assessment, but when confounders are present, such as sedative medications or metabolic derangements, additional tests are needed to demonstrate absent blood flow to the brain. Computed tomography perfusion (CTP) and CT angiography (CTA) potentially could be used for this purpose, but their diagnostic accuracy is uncertain.
Investigators in Canada enrolled 333 adult patients with acute, severe brain injuries that resulted in potential DNC; 51 patients were excluded after enrollment…