| The probability of inevitability: the inherent impossibility of validating criteria for brain death or 'irreversibility' through clinical studies. | |
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MedLine Citation:
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PMID: 3659664 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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A great need persists for diagnostic criteria for both brain death in young children and irreversible loss of consciousness at all ages. This article examines the inferences derived from a hypothetical confirmatory study in which all of the N patients who fulfilled the criterion did in fact experience brain death (irreversibility). A Bayesian methodology proves that, for N in the range of a large clinical study, estimations of prior probabilities are, for all practical purposes, irrelevant to the calculation of the posterior probabilities. The risk of a false positive diagnosis for the next patient who meets the criterion is approximately 1/(N + 2). The chance of at least one false positive diagnosis among the next (N + 1) patients who meet the criterion is around 50 per cent. Thus, achievement of the requisite moral certainty of a declaration of death (irreversibility) necessitates an impossibly large N for the study. This does not mean that one cannot diagnose death, but rather that the validity of the diagnostic criteria must be self-evident on a priori grounds, and that confirmatory studies are necessarily either inadequate or superfluous. |
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Authors:
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D A Shewmon |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Statistics in medicine Volume: 6 ISSN: 0277-6715 ISO Abbreviation: Stat Med Publication Date: 1987 Jul-Aug |
Date Detail:
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Created Date: 1987-11-05 Completed Date: 1987-11-05 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8215016 Medline TA: Stat Med Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 535-53 Citation Subset: IM |
Affiliation:
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Department of Pediatrics, UCLA Medical Center 90024. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Bayes Theorem* Brain Death / diagnosis* Child Child, Preschool Coma / diagnosis Consciousness Diagnosis, Differential Humans Infant Infant, Newborn Predictive Value of Tests Probability* |
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