BACKGROUND: In 1998, the Stroke Prevention Trial in Sickle Cell Anemia showed a >90% reduction in stroke rates after blood transfusion therapy in children with sickle cell disease (SCD) identified as high risk with transcranial Doppler ultrasonography (TCD) screening. METHODS: We studied the utilization of TCD screening in a retrospective cohort of all children with SCD within a large managed care plan from January 1993 to December 2005. Rates of first TCD screening were estimated using life table methods; predictors of TCD were evaluated using Cox proportional hazards regression. Stroke incidence rates were estimated in person-time before (pre-TCD) and after (post-TCD) first TCD. RESULTS: The average annual rate of TCD screening in 157 children with SCD was 1.8 per 100 person-years pre-1998, 5.0 from January 1, 1998, to December 31, 1999, and 11.4 after 1999. The only independent predictor of TCD screening was proximity to the vascular laboratory. The annualized stroke rate pre-TCD was 0.44 per 100 person-years, compared to 0.19 post-TCD. CONCLUSIONS: Since the Stroke Prevention Trial in Sickle Cell Anemia, the rate of transcranial Doppler ultrasonography (TCD) screening in sickle cell disease (SCD) has increased sixfold within a large health care plan. Children living farther from a vascular laboratory are less likely to be screened. Increased availability of TCD screening could improve the utilization of this effective primary stroke prevention strategy.
BACKGROUND: In 1998, the Stroke Prevention Trial in Sickle Cell Anemia showed a >90% reduction in stroke rates after blood transfusion therapy in children with sickle cell disease (SCD) identified as high risk with transcranial Doppler ultrasonography (TCD) screening. METHODS: We studied the utilization of TCD screening in a retrospective cohort of all children with SCD within a large managed care plan from January 1993 to December 2005. Rates of first TCD screening were estimated using life table methods; predictors of TCD were evaluated using Cox proportional hazards regression. Stroke incidence rates were estimated in person-time before (pre-TCD) and after (post-TCD) first TCD. RESULTS: The average annual rate of TCD screening in 157 children with SCD was 1.8 per 100 person-years pre-1998, 5.0 from January 1, 1998, to December 31, 1999, and 11.4 after 1999. The only independent predictor of TCD screening was proximity to the vascular laboratory. The annualized stroke rate pre-TCD was 0.44 per 100 person-years, compared to 0.19 post-TCD. CONCLUSIONS: Since the Stroke Prevention Trial in Sickle Cell Anemia, the rate of transcranial Doppler ultrasonography (TCD) screening in sickle cell disease (SCD) has increased sixfold within a large health care plan. Children living farther from a vascular laboratory are less likely to be screened. Increased availability of TCD screening could improve the utilization of this effective primary stroke prevention strategy.
Authors: Cindy E Neunert; Robert W Gibson; Peter A Lane; Pragya Verma-Bhatnagar; Vaughn Barry; Mei Zhou; Angela Snyder Journal: Am J Prev Med Date: 2016-07 Impact factor: 5.043
Authors: David G Bundy; John Muschelli; Gwendolyn D Clemens; John J Strouse; Richard E Thompson; James F Casella; Marlene R Miller Journal: J Pediatr Hematol Oncol Date: 2016-05 Impact factor: 1.289
Authors: Adam M Bush; Matthew T Borzage; Soyoung Choi; Lena Václavů; Benita Tamrazi; Aart J Nederveen; Thomas D Coates; John C Wood Journal: Am J Hematol Date: 2016-07-04 Impact factor: 10.047
Authors: John C Wood; Alan R Cohen; Sara L Pressel; Banu Aygun; Hamayun Imran; Lori Luchtman-Jones; Alexis A Thompson; Beng Fuh; William H Schultz; Barry R Davis; Russell E Ware Journal: Br J Haematol Date: 2015-11-02 Impact factor: 6.998