To early identify the potential brain death donors, a user-friendly and more accurate scale was constructed based on the Glasgow coma scale (GCS), brainstem reflex and spontaneous respiration assessment.

From January 1, 2021 to June 30, 2023, neurocritical patients in coma, admitted to the First Affiliated Hospital of SYSU and determined as brain death ultimately were retrospectively included as the retrospective group (n=175). Based on existing and previous studies of our center, the factors related to the progression to brain death of such patients were recorded, including GCS, brainstem reflexes (such as pupillary light reflex, corneal reflex, and vestibulo-ocular reflex), and spontaneous respiratory status. Brain death determination was according to the current criteria for brain death determination in China, and was completed by specialized doctors in our center. In the retrospective group, the relevant factors of the progression to brain death within 14 d after brain injury were screened, and were utilized to bulid the GCS-pupillary light reflex (P)-spontaneous respiratory (R) scale. From July 1, 2023 to January 31, 2024, the comatose neurocritical patients, admitted to our hospital and determined as brain death ultimately, were prospectively included as the prospectively group (n=51). In the prospectively group, the the efficacy of constructed GCS-P-R scale was verified. The comparison of quantitative data between groups was conducted with group t-test, and Logistic regression was used to analyze the risk factors for the progression of brain death in comatose neurocritical patients within 14 d after brain injury. The sensitivity and specificity of GCS-P-R scale and GCS were caculated in determining the progression to brain death in comatose neurocritical patients within 14 d after brain injury, and compared with chi square test. P<0.05 was indicated statistical significance of the difference.

In the retrospective group, statistical analysis showed that GCS=3 (OR=3.86, 95%CI: 1.57-18.21), disappearance of light reflex in unilateral pupil (OR=6.83, 95%CI: 4.35-19.34), and the frequency of spontaneous respiratory less than the set frequency (OR=4.16, 95%CI: 1.63-15.52) were the related factors with the progression to brain death within 14 d after brain injury. The GCS-P-R scale score≤0 can be used for early identification of potential organ donors after brain death. In the prospective group, 41 cases (80.4%) progressed to brain death within 14 d after brain injury. According to the GCS-P-R scale score ≤ 0, the sensitivity and specificity of predicting brain death progression within 14 d after brain injury were 92.7% and 43.5%, respectively. The sensitivity and specificity of predicting brain death within 14 d after brain injury based on GCS ≤ 6 were 100% and 0, respectively, the difference of sensitivity between the two groups was statistically significant (χ²=4.898, P<0.05), indicating that the constructed GCS-P-R scale has better predictive performance than GCS.

The GCS-P-R scale which includes pupillary light reflex and spontaneous respiratory assessment, can more accurately predict the progression to brain death within 14 d in comatose neurocritical patients, and can be used for early identification of potential organ donors after brain death.