{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:38:36Z","timestamp":1792625916597,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cerebral computed tomography angiography (CTA) is increasingly incorporated into national guidelines to confirm cerebral circulatory arrest during the determination of death using neurological criteria. However, implementation remains limited due to studies showing variable sensitivity. Clinical observations suggest the time elapsed from the onset of initial signs of brainstem areflexia, defined as the appearance of fixed and dilated pupils and loss of cough and gag reflexes, significantly influences CTA sensitivity. This study aimed to evaluate the impact of this time interval on test sensitivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively assessed 118 intensive care unit patients undergoing determination of death using neurological criteria. Cerebral CTA was used to confirm cerebral circulatory arrest based on a four\u2010point scoring system. Patients were categorised according to the time elapsed from the onset of initial signs of brainstem areflexia to the investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Cerebral CTA did not confirm cerebral circulatory arrest in 15\/118 (13%) patients, yielding an overall sensitivity of 87.3% (95%CI 79.6\u201392.5%). Notably, 93.3% (95%CI 66.0\u201399.7%) of false\u2010negative results occurred within 12\u2009h of the onset of initial signs of brainstem areflexia. Patients were secondarily stratified into early (\u2264\u200912\u2009h) and late (&gt;\u200912\u2009h) groups, revealing a significantly higher sensitivity in the late group (67.4%, 95%CI 51.3\u201380.5% vs. 98.7%, 95%CI 91.8\u2013100%, p\u2009&lt;\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The sensitivity of cerebral CTA increases with the time elapsed after the onset of initial signs of brainstem areflexia. We recommend delaying cerebral CTA until at least 12\u2009h after the onset of initial signs of brainstem areflexia, and, in case of inconclusive results, test repetition at least 12\u2009h later. Further work is required to confirm our findings and increase diagnostic confidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.70438","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:55:07Z","timestamp":1792623307000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimum timing of cerebral computed tomography angiography for determination of death using neurological criteria: a retrospective sensitivity cohort study"],"prefix":"10.1111","author":[{"given":"Romuald","family":"Bohatyrewicz","sequence":"first","affiliation":[{"name":"Pomeranian Medical University  Szczecin Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0129-2343","authenticated-orcid":false,"given":"Marcin","family":"Sawicki","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Interventional Radiology Pomeranian Medical University  Szczecin Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Chamier\u2010Ciemi\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Interventional Radiology Pomeranian Medical University  Szczecin Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0141ukasz","family":"Zwarzany","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Interventional Radiology Pomeranian Medical University  Szczecin Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Kotfis","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine Vanderbilt University Medical Center  Nashville TN 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Medical Sciences University of Opole  Opole Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"El\u017cbieta","family":"Byrska\u2010Maciejasz","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy University Children's Hospital of Cracow  Cracow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3129-9768","authenticated-orcid":false,"given":"Wojciech","family":"Saucha","sequence":"additional","affiliation":[{"name":"University Children's Hospital of Cracow  Cracow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Wojczal","sequence":"additional","affiliation":[{"name":"Department of Neurology Medical University of Lublin  Lublin Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"D\u0105browski","sequence":"additional","affiliation":[{"name":"First Department of Anaesthesiology and Intensive Therapy Medical University of Lublin  Lublin Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip","family":"Szeremeta","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy Silesian Hospital in Cieszyn  Cieszyn Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Poncyljusz","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Interventional Radiology Pomeranian Medical University  Szczecin Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.11586"},{"key":"e_1_2_6_3_1","unstructured":"Academy of Medical Royal Colleges.A Code of Practice for the diagnosis and confirmation of death: 2025 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