Clinical utility and limitations of transcranial Doppler in evaluating pediatric brain death or death by neurologic criteria: a 10-year retrospective study
- 1Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health , ,
- 2Department of Emergency Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health , ,
Abstract
Objective: To evaluate the performance of transcranial Doppler (TCD) in pediatric brain death or death by neurologic criteria (BD/DNC) and factors contributing to discordance between TCD and clinical examination.
Methods: We retrospectively analyzed 512 children admitted to the pediatric intensive care unit between 2016 and 2025 who underwent TCD when the Glasgow Coma Scale score was 3 T. Patients were classified as BD/DNC (n = 47), non-BD/DNC (n = 266), or incomplete determination (n = 199) according to the status of BD/DNC determination. TCD findings and cases of TCD-clinical discordance were analyzed.
Results: TCD findings consistent with BD/DNC were observed in 80.9% (38/47) of the BD/DNC group, none of the non-BD/DNC group, and 58.8% (117/199) of the incomplete determination group. Among 9 patients with clinical examination consistent with BD/DNC but TCD findings inconsistent with BD/DNC, intracranial arterial flow remained detectable. Factors potentially contributing to the discordance included disruption of the closed intracranial system (ventricular drainage, patent anterior fontanelle, or multiple skull fractures; n = 4), venoarterial extracorporeal membrane oxygenation support (n = 1), cerebrovascular malformations (n = 1), and delayed TCD examination (n = 1).
Conclusions: TCD findings consistent with BD/DNC strongly support the diagnosis of BD/DNC. Given its noninvasive and bedside applicability, TCD has the potential to be a valuable ancillary tool in pediatric BD/DNC evaluation. However, intracranial arterial flow can still be detected in a subset of children with clinically confirmed BD/DNC, underscoring the importance of considering potential interfering factors when TCD is used as a confirmatory test for pediatric BD/DNC.
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BibTeX
@article{tan2026clinical,
title = {{Clinical utility and limitations of transcranial Doppler in evaluating pediatric brain death or death by neurologic criteria: a 10-year retrospective study}},
author = {Na Tan and Yan Li and Ningning Xiao and Quan Wang and Jie Wu and Suyun Qian},
journal = {Frontiers in pediatrics},
year = {2026},
month = oct,
doi = {10.3389/fped.2026.1931129},
url = {https://europepmc.org/article/PMC/PMC13727551},
note = {CC BY},
}
RIS
TY - JOUR
TI - Clinical utility and limitations of transcranial Doppler in evaluating pediatric brain death or death by neurologic criteria: a 10-year retrospective study
AU - Na Tan
AU - Yan Li
AU - Ningning Xiao
AU - Quan Wang
AU - Jie Wu
AU - Suyun Qian
PY - 2026
DA - 2026/10/20
JO - Frontiers in pediatrics
DO - 10.3389/fped.2026.1931129
UR - https://europepmc.org/article/PMC/PMC13727551
AB - Objective: To evaluate the performance of transcranial Doppler (TCD) in pediatric brain death or death by neurologic criteria (BD/DNC) and factors contributing to discordance between TCD and clinical examination. Methods: We retrospectively analyzed 512 children admitted to the pediatric intensive care unit between 2016 and 2025 who underwent TCD when the Glasgow Coma Scale score was 3 T. Patients were classified as BD/DNC (n = 47), non-BD/DNC (n = 266), or incomplete determination (n = 199) according to the status of BD/DNC determination. TCD findings and cases of TCD-clinical discordance were analyzed. Results: TCD findings consistent with BD/DNC were observed in 80.9% (38/47) of the BD/DNC group, none of the non-BD/DNC group, and 58.8% (117/199) of the incomplete determination group. Among 9 patients with clinical examination consistent with BD/DNC but TCD findings inconsistent with BD/DNC, intracranial arterial flow remained detectable. Factors potentially contributing to the discordance included disruption of the closed intracranial system (ventricular drainage, patent anterior fontanelle, or multiple skull fractures; n = 4), venoarterial extracorporeal membrane oxygenation support (n = 1), cerebrovascular malformations (n = 1), and delayed TCD examination (n = 1). Conclusions: TCD findings consistent with BD/DNC strongly support the diagnosis of BD/DNC. Given its noninvasive and bedside applicability, TCD has the potential to be a valuable ancillary tool in pediatric BD/DNC evaluation. However, intracranial arterial flow can still be detected in a subset of children with clinically confirmed BD/DNC, underscoring the importance of considering potential interfering factors when TCD is used as a confirmatory test for pediatric BD/DNC.
SN - 2296-2360
ER -