Determination of Death by Neurological Criteria in Children and Its Concordance With Ancillary Testing, Primarily With CT Angiography: Single-Center Experience in Türkiye, 2012-2025.

OBJECTIVES: Our practice in Türkiye when determining death using neurologic criteria (DNC) is to combine clinical examination and ancillary radiological investigation. We have: 1) examined the diagnostic concordance between clinical examination for DNC and the initial ancillary investigation; 2) evaluated an age cutoff of 24 months in the diagnostic clinical-radiological concordance; and 3) explored age and radiological diagnostic relationships in children with incomplete clinical assessment for DNC. DESIGN: Single-center retrospective study, 2012-2025. SETTING: Academic hospital PICU in İstanbul, Türkiye. PATIENTS: We included patients younger than 19 years old in whom DNC was suspected. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: DNC was suspected in 86 patients. Clinical examination consistent with DNC was completed in 61 patients (mean age, 82.1 mo; 16 < 24 and 45 ≥ 24 mo) with ancillary investigation, which were concordant with DNC either on the first test (77%) or after two or more tests (23%). CT angiography (CTA) was the most used test (80%). The initial CTAs were not consistent with DNC in 23% (95% CI, 13-36%). Based on age grouping (< 24 or ≥ 24 mo), being younger was associated with greater odds of a discordant result (8/16 vs. 6/45; odds ratio, 6.5; 95% CI, 1.77-29.93; p = 0.005). Last, in 15 patients (mean age, 43.6 mo) with suspected DNC, but either incomplete clinical examination (n = 9) or apnea test (n = 6), DNC was finally confirmed using CTA, with five of 15 patients having more than one test. CONCLUSIONS: In Türkiye, where ancillary investigation is mandatory following a clinical examination consistent with DNC, and where more advanced imaging modalities are unavailable, our practice has been to use CTA. Our 2012-2025 experience of determining DNC shows that CTA is used in the pediatric population, even in children under 2 years old.