Abstract
Background. Although transcranial Doppler ultrasonography (TCD) screening is effective in identifying children with sickle cell anemia (SCA) who are at high risk of stroke, not all children are screened. In 2003, we instituted a comprehensive TCD screening program designed to screen all at-risk children treated at our sickle cell center. Procedure. We evaluated the efficacy of our program by comparing the number of patients screened per year and incidence of first stroke across three periods defined by TCD usage: (1) predating TCD screening, (2) sporadic TCD screening, and (3) comprehensive TCD screening. Results. During Period 2, an average of 52 patients/year were screened. In Period 3, an average of 95 patients/year were screened representing 99% of the at-risk population. Eighteen strokes occurred in Period 1, 22 in Period 2 and three in Period 3. The first stroke incidence was significantly lower in Period 3 compared to Periods 1 and 2 (P = 0.047). Furthermore, of the 25 patients in Periods 2 and 3 who had stroke, only six had received TCD screening (four in Period 2, two in Period 3). These six either declined prophylactic transfusion therapy (n = 2), had co-existing stroke risk factors (n = 2), or did not return for appropriate TCD follow-up (n = 2). Therefore, strokes that occurred were not the result of a failure of TCD screening per se. Conclusions. It is possible to perform TCD screening of most children with SCA. TCD screening is effective in reducing first stroke incidence in these children.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 818-821 |
| Number of pages | 4 |
| Journal | Pediatric Blood and Cancer |
| Volume | 50 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 2008 |
| Externally published | Yes |
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Keywords
- Children
- Sickle cell anemia
- Stroke
- Transcranial Doppler ultrasound
ASJC Scopus subject areas
- Cancer Research
- Pediatrics, Perinatology, and Child Health
- Hematology
Cite this
Evaluation of a comprehensive transcranial Doppler screening program for children with sickle cell anemia. / McCarville, M. Beth; Goodin, Geoffrey S.; Fortner, Gail; Li, Chin-Shang; Smeltzer, Matthew P.; Adams, Robert; Wang, Winfred.
In: Pediatric Blood and Cancer, Vol. 50, No. 4, 04.2008, p. 818-821.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Evaluation of a comprehensive transcranial Doppler screening program for children with sickle cell anemia
AU - McCarville, M. Beth
AU - Goodin, Geoffrey S.
AU - Fortner, Gail
AU - Li, Chin-Shang
AU - Smeltzer, Matthew P.
AU - Adams, Robert
AU - Wang, Winfred
PY - 2008/4
Y1 - 2008/4
N2 - Background. Although transcranial Doppler ultrasonography (TCD) screening is effective in identifying children with sickle cell anemia (SCA) who are at high risk of stroke, not all children are screened. In 2003, we instituted a comprehensive TCD screening program designed to screen all at-risk children treated at our sickle cell center. Procedure. We evaluated the efficacy of our program by comparing the number of patients screened per year and incidence of first stroke across three periods defined by TCD usage: (1) predating TCD screening, (2) sporadic TCD screening, and (3) comprehensive TCD screening. Results. During Period 2, an average of 52 patients/year were screened. In Period 3, an average of 95 patients/year were screened representing 99% of the at-risk population. Eighteen strokes occurred in Period 1, 22 in Period 2 and three in Period 3. The first stroke incidence was significantly lower in Period 3 compared to Periods 1 and 2 (P = 0.047). Furthermore, of the 25 patients in Periods 2 and 3 who had stroke, only six had received TCD screening (four in Period 2, two in Period 3). These six either declined prophylactic transfusion therapy (n = 2), had co-existing stroke risk factors (n = 2), or did not return for appropriate TCD follow-up (n = 2). Therefore, strokes that occurred were not the result of a failure of TCD screening per se. Conclusions. It is possible to perform TCD screening of most children with SCA. TCD screening is effective in reducing first stroke incidence in these children.
AB - Background. Although transcranial Doppler ultrasonography (TCD) screening is effective in identifying children with sickle cell anemia (SCA) who are at high risk of stroke, not all children are screened. In 2003, we instituted a comprehensive TCD screening program designed to screen all at-risk children treated at our sickle cell center. Procedure. We evaluated the efficacy of our program by comparing the number of patients screened per year and incidence of first stroke across three periods defined by TCD usage: (1) predating TCD screening, (2) sporadic TCD screening, and (3) comprehensive TCD screening. Results. During Period 2, an average of 52 patients/year were screened. In Period 3, an average of 95 patients/year were screened representing 99% of the at-risk population. Eighteen strokes occurred in Period 1, 22 in Period 2 and three in Period 3. The first stroke incidence was significantly lower in Period 3 compared to Periods 1 and 2 (P = 0.047). Furthermore, of the 25 patients in Periods 2 and 3 who had stroke, only six had received TCD screening (four in Period 2, two in Period 3). These six either declined prophylactic transfusion therapy (n = 2), had co-existing stroke risk factors (n = 2), or did not return for appropriate TCD follow-up (n = 2). Therefore, strokes that occurred were not the result of a failure of TCD screening per se. Conclusions. It is possible to perform TCD screening of most children with SCA. TCD screening is effective in reducing first stroke incidence in these children.
KW - Children
KW - Sickle cell anemia
KW - Stroke
KW - Transcranial Doppler ultrasound
UR - http://www.scopus.com/inward/record.url?scp=40449092927&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=40449092927&partnerID=8YFLogxK
U2 - 10.1002/pbc.21430
DO - 10.1002/pbc.21430
M3 - Article
C2 - 18085672
AN - SCOPUS:40449092927
VL - 50
SP - 818
EP - 821
JO - Pediatric Blood and Cancer
JF - Pediatric Blood and Cancer
SN - 1545-5009
IS - 4
ER -