The 2023 AAN BD/DNC Guideline states that clinicians should have specific training to perform BDTs. NCC physicians have expertise in systemic critical illness and neurology, but how NCC involvement influences diagnostic practices and organ donation has yet to be established.

In a multi-hospital system, we used ICD-9/10 codes to retrospectively identify BD-diagnosed adult patients over a 10-year period. We analyzed ICU location, NCC involvement, time between BD suspicion and diagnosis, ancillary testing use, and organ donation rates. Medians, IQRs, and odds ratios (ORs) with 95% CIs were reported. P-values were computed using Wilcoxon rank sum and Chi-square tests. 

We identified 298 patients diagnosed with BD per protocol. NeuroICU patients had shorter lengths of stay (2 days (IQR 1-5) vs. 5 (IQR 3-7); p<0.001) and shorter durations between suspicion for BD and testing (20 hours (IQR 10-28) vs. 29 (IQR 16-48); p<0.001) than non-NeuroICU patients. Patients cared for by neurointensivists were more likely to have ancillary testing (87% vs 52%, OR=6.1, 95%CI= [5.5, 6.7], p<0.001). 44% of NeuroICU patients had 2 ancillary tests vs. 19% of M/SICU patients (OR=3.5, 95%CI=[2.9, 4.1], p<0.001). In M/SICUs, 41% of NCC-consulted cases had 2 ancillary tests vs. 0% (n=0) of non-consulted cases (OR=61, 95% CI=[58, 64], p<0.001). NeuroICU patients had higher rates of organ donation (70% vs. 32%, OR=4.8, 95%CI=[4.3, 5.3], p<0.001). In M/SICUs, 61% of NCC-consulted cases donated organs vs. 33% of non-consulted cases (OR=3.1, 95%CI=[2.4, 3.8], p=0.002).

NCC physicians used more ancillary testing; but, their patients had shorter LOS, shorter intervals between suspected and confirmed BD, and increased organ donation rates.