2026 American Academy of Neurology Abstract Website

Neil Dhruva¹, Daniel Harrison¹, Jenna Ford², David Greer³, Sarah Wahlster⁴, Nikita Chhabra⁵, Ariane Lewis⁶, Lori Shutter⁷, Michael Rubin⁸, Panayiotis Varelas⁹, Katharina Busl¹⁰, Matthew Kirschen¹¹, Thomas Nakagawa¹², Paul Vespa¹³, Cherylee Chang¹⁴, David Bauer¹⁵, Carolina Maciel¹⁶, Michael Souter¹⁷, Fernando Goldenberg¹⁸, Conall Francoeur¹⁹, Thomas Bleck²⁰, Gene Sung²¹, Sarah Nelson²², Lauren Koffman²³, Evadne Marcolini²⁴, Samuel Galvagno²⁵, Christa O'hana Nobleza²⁶, Brenda Fahy¹⁶, Ivan Rocha Ferreria da Silva¹⁶, Alejandro Rabinstein²⁷, Abhay Kumar²⁸, Jordan Bonomo²⁹, Claude Hemphill³⁰, Rahul Nanchal³¹, Bradley Dengler³², Nicholas Morris³³
¹Boston Medical Center, ²Northwestern, ³Boston University School of Medicine, ⁴University of Washington, Seattle, ⁵University of Michigan, Ann Arbor, ⁶NYU Langone Medical Center, ⁷UPMC Dept of Critical Care Medicine, ⁸UT Southwestern Medical Center, ⁹Albany Med-Department of Neurology, ¹⁰University of Florida, ¹¹CHOP, ¹²University of Florida, College of Medicine, Jacksonville, ¹³UCLA, ¹⁴Duke University, ¹⁵Baylor College of Medicine, ¹⁶University of Florida, Gainesville, ¹⁷Harborview Medical Center, University of Washington, ¹⁸University of Chicago, ¹⁹McGill Univeristy, ²⁰Northwestern University Department of Neurology, ²¹U.S.C. Neurology, ²²Tufts Medical Center, ²³Temple University Hospital, ²⁴Geisel School of Medicine, Dartmouth, ²⁵University of Maryland, School of Medicine, ²⁶University of Tennessee Health Science Center, Memphis, ²⁷Mayo Clinic, ²⁸McGovern Medical School at UTHealth Houston, ²⁹University of Cincinnati College of Medicine, ³⁰Zuckerberg San Francisco General Hospital, ³¹Medical College of Wisconsin, Milwaukee, ³²Uniformed Services University of the Health Sciences, ³³University of Maryland Medical Center

Objective:

To develop a checklist, define critical actions, and set a minimal passing standard (MPS) for formative and summative assessment of brain death/death by neurologic criteria (BD/DNC) determination.

Background:

Clinician competence in BD/DNC determination is assumed but not established. Simulation-based mastery learning supports both training and assessment but requires a checklist and MPS supported by validity evidence, neither of which exists in BD/DNC.

Design/Methods:

A three-round modified Delphi consensus process defined checklist items, followed by a modified Angoff process to identify critical actions and establish the MPS. Delphi panelists included authors of the 2023 BD/DNC Consensus Guideline, World Brain Death Project, and experts recommended by these authors. Angoff panelists included United Council for Neurologic Subspecialties and Accreditation Council for Graduate Medical Education Neurocritical Care Examination Committee members. The steering committee generated candidate items, which Delphi panelists rated on a 5-point importance scale. Panelists were allowed to suggest new items and modifications during initial rounds. Items with >80% consensus were retained. Angoff panelists estimated the percentage of minimally competent learners expected to complete each checklist item during a BD/DNC case simulation. Items rated “100%” by >80% of panelists were designated critical (“can’t miss”). All others were deemed non-critical, allowing participants to miss these items and achieve competency if the MPS was met.

Results:

Ninety-eight checklist items were retained across four domains: prerequisites (23), clinical examination (28), apnea testing (36), and ancillary testing (11). Seven items were designated as critical actions. The remaining 91 items were assigned item average ratings. The minimum passing score for an assessment including all items was set at 89%.

Conclusions:

This guideline-concordant, consensus-derived checklist establishes an MPS for BD/DNC assessment, distinguishing critical from non-critical actions. Selective application of the checklist to simulated cases will facilitate assessment of competence and readiness for independent BD/DNC determination.