Can pediatricians define and apply the concept of brain death?

Objective. We sought to determine pediatric residents' and attending physic ians' ability to define brain death, their ability to apply this standard o f death to a clinical scenario, and their knowledge regarding the legal nec essity of confirmatory testing when determining death by brain criteria. We compared resident and attending self-confidence at discussing brain death with their ability to define brain death and apply this concept to a clinic al scenario. Methodology. A questionnaire was sent to 136 residents, postgraduate years 1 through 3, at four accredited pediatric training programs in the United S tates. Participation was tracked by return address. One follow-up request f or participation was made. A similar procedure was followed for 140 faculty pediatricians at two of the institutions. Demographic information including level of training, subspecialty training, training program, and formal ethics training was collected. Respondents de fined brain death, interpreted a clinical scenario, and stated whether conf irmatory testing is legally required to determine death by brain criteria. Respondents rated their confidence at explaining brain death to a patient's family on a scale from 1 to 5. Results. Eighty-seven percent (118/136) of resident surveys were returned. Thirty-six percent (42/118) of the residents correctly defined brain death. Forty-three percent (51/118) of residents correctly interpreted the clinic al scenario. Fifty-five percent (65/118) of the residents correctly recogni zed that brain death could be determined without a confirmatory test. Resid ents who correctly defined brain death were as confident as those who did n ot (2.8 +/- 1 vs 1.5 +/- 1). Residents who correctly interpreted the clinic al scenario were as confident as those who did not (2.6 +/- I vs 1.9 +/- 0. 9). Eighty percent (112/140) of attending physician surveys were returned. Thir ty-nine percent (44/112) of attending physicians correctly defined brain de ath. Fifty-three percent (59/112) correctly interpreted the clinical scenar io. Fifty-eight percent (65/112) recognized that brain death can be diagnos ed without confirmatory testing. All pediatric intensivists (n = 12) correc tly answered all three questions. Their performance was significantly bette r than other pediatricians. Attendings who correctly defined brain death we re more confident than those who did not (4.2 +/- 1 vs 1.1 +/- 0.9). Attend ings who correctly interpreted the clinical scenario were more confident th an those who did not (3.8 +/- 1.2 vs 2.2 +/- 1.2). Conclusions. Pediatric residents and attendings have difficulty defining an d applying the concept of brain death. This concept is difficult to grasp a nd internalize for many pediatricians. To ensure that critical decisions ar e made by knowledgeable physicians and well-informed families, more effecti ve educational strategies need to be identified.