Table 3:

Survey Participant Pediatric Brain Death Determination Practices

	2013 Survey	2020 Survey	p value
I have found the revised pediatric brain death guideline…			0.0484
Useful in my clinical practice	204 (83.3%)	133 (93.7%)
Not useful in my clinical practice	8 (3.3%)	3 (2.1%)
I have not had the opportunity to use the revised guidelines to determine brain death	20 (8.2%)	3 (2.1%)
Complicated and confusing	8 (3.3%)	2 (1.4%)
I was not aware that revised guidelines have been published.	5 (2.0%)	1 (0.7%)
How have the new guidelines impacted your clinical practice in the determination of brain death for infants and children? [Check all that apply]:
Provided more consistency and clarity in the determination of death	137 (63.1%)	104 (73.2%)	0.0462
The checklist provides uniform documentation for determination of brain death	119 (54.8%)	97 (68.3%)	0.0162
I do not use the guidelines	33 (15.2%)	5 (3.5%)	0.0012
The guidelines have made determination of brain death more difficult	-	6 (4.2%)
Need for a second examination after ancillary testing	-	2 (1.4%)
Has not made it more difficult	-	1 (0.7%)
Need for two apnea tests	-	2 (1.4%)
Difficult to perform two apnea tests in patients with severe oxygenation impairment	-	1 (0.7%)
Do all members of your division use the revised guidelines consistently?			<0.0001
Yes, as part of revised hospital policy	122 (51.9%)	114 (80.3%)
I use ancillary studies to assist with declaration of brain death in the following situations [Check all that apply]:
When the clinical examination and apnea is inconclusive or cannot be completed	206 (84.8%)	129 (90.8%)	0.0873
To reduce the observation period between clinical examinations	113 (46.5%)	86 (60.6%)	0.0308
I do not typically use ancillary studies to confirm brain death	33 (13.6%)	11 (7.7%)	0.0873
For all patients who are undergoing brain death testing	24 (9.9%)	5 (3.5%)	0.0452
Are you aware that the revised guidelines suggest 2 clinical examinations even if an ancillary study has been performed and supports the diagnosis of brain death?			0.48
Yes	233 (94.7%)	132 (93.0%)
No	13 (5.3%)	10 (7.0%)
Are you aware that the revised guidelines suggest 2 separate attending physicians perform the clinical examinations?			0.7527
Yes	238 (96.7%)	139 (97.9%)
No	8 (3.3%)	3 (2.1%)
Have you found the checklist included in the revised brain death guidelines to be useful in your clinical practice to determine brain death in infants and children? [Check all that apply]:
Yes	114 (64.8%)	-
No	11 (6.3%)	-
I use my hospitals template developed off the checklist included in the revised brain death guidelines	-	78 (54.9%)
I document using the checklist or template included in the revised brain death guidelines	-	28 (19.7%)
I use my hospitals template or checklist	63 (35.8%)	54 (38.0%)	0.9116
I am unaware of a checklist within the guidelines	7 (4.0%)	6 (4.2%)	0.9116
I document brain death using a free text hand written or electronic note	15 (8.5%)	30 (21.1%)	0.0039
I do not use a checklist	1 (0.6%)	-
Have you specifically modified the checklist included in the revised brain death guidelines (other than hospital identification) to meet your clinical practice needs?			0.0091
Yes	40 (30.8%)	2 (7.1%)
No	90 (69.2%)	26 (92.9%)
Which tables and appendices have been most helpful in your practice? [Check all that apply]:
Checklist	148 (71.8%)	99 (69.7%)	0.6917
Summary recommendations table	116 (56.3%)	83 (58.5%)	0.6917
Algorithm	69 (33.5%)	55 (38.7%)	0.4424
Pharmacokinetic drug elimination table	55 (26.7%)	52 (36.6%)	0.1482
Comparison of the 1987 and Currently Revised Guidelines	47 (22.8%)	21 (14.8%)	0.1482
Summary of apnea testing studies	30 (14.6%)	29 (20.4%)	0.2664
Ancillary study diagnostic yield tables (3 tables)	30 (14.6%)	32 (22.5%)	0.1482