The use of cerebral <scp>CT</scp> angiography as an ancillary investigation to support a clinical diagnosis of death using neurological criteria
Bibliographic record
Abstract
We welcome the publication of the guideline by Thomas et al. [1]. It offers clear and comprehensive instructions on the indications, conduct and interpretation of 4-point CT angiography for ancillary testing to aid the confirmation of death by neurological criteria. However, the guideline does not include any specific comment on isolated infratentorial brain pathology or injury. The Faculty of Intensive Care Medicine form for diagnosing death using neurological criteria states that lesions primarily located in the brainstem or posterior fossa such as infratentorial stroke or brain injury are a ‘red flag’ patient group necessitating diagnostic caution and ancillary or confirmatory tests, such as cerebral CT angiography, to confirm death by neurological criteria [2]. This group of patients, while fulfilling the criteria for death by neurological criteria, may still have supratentorial blood flow when CT angiography is performed. A recent Canadian guideline recommends that CT angiography is repeated in this clinical situation because these patients will eventually have complete cessation of both supratentorial and infratentorial flow, supporting the confirmation of death by neurological criteria [3]. There is also some variability in how long this could take because of factors such as ongoing somatic support or posterior fossa decompression surgery like a ventriculostomy. Furthermore, an Academy of Medical Royal Colleges document [4] states the diagnosis of death because of cessation of brainstem function does not need to include the cessation of all neurological activity in the brain. Accordingly, supratentorial blood flow may still be present in a patient with brainstem death even though they have no form of consciousness associated with human life, such as the ability to feel, be aware or do anything [4]. This is in contrast to countries like Canada which has embraced a brain-based definition of death [5]. The distinction between brainstem death and whole-brain death is not as clear in the UK guidance and we would be interested to know the authors' views on a brain-based definition of death [5].
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".