Evaluation of a comprehensive transcranial Doppler screening program for children with sickle cell anemia

M. Beth McCarville, Geoffrey S. Goodin, Gail Fortner, Chin-Shang Li, Matthew P. Smeltzer, Robert Adams, Winfred Wang

Research output: Contribution to journalArticle

57 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)818-821
Number of pages4
JournalPediatric Blood and Cancer
Volume50
Issue number4
DOIs
StatePublished - Apr 2008
Externally publishedYes

Fingerprint

Doppler Transcranial Ultrasonography
Sickle Cell Anemia
Stroke
Incidence

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 journalArticle

McCarville, M. Beth ; Goodin, Geoffrey S. ; Fortner, Gail ; Li, Chin-Shang ; Smeltzer, Matthew P. ; Adams, Robert ; Wang, Winfred. / Evaluation of a comprehensive transcranial Doppler screening program for children with sickle cell anemia. In: Pediatric Blood and Cancer. 2008 ; Vol. 50, No. 4. pp. 818-821.
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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.",
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AU - McCarville, M. Beth

AU - Goodin, Geoffrey S.

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AU - Adams, Robert

AU - Wang, Winfred

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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

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KW - Transcranial Doppler ultrasound

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