Stroke prevention in the young child with sickle cell anaemia

Roberts, Lara N.; O’Driscoll, Sandra; Dick, Moira; Height, Sue; Deane, Colin; Goss, David; Pohl, Keith; Rees, David C.

doi:10.1007/s00277-009-0757-z

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…This was primarily related to patient age, being unusual after 3 years of age (Table 1, Fig 2). However, it is at this age that TCD scans are most important, in that the peak stroke incidence is from 2–5 years[4, 28], and the first few scans represent the best opportunity to identify cerebrovascular disease at an early stage, and to start treatment before significant vascular or brain damage has occurred. The child may be better able to tolerate the procedure in a child-friendly environment, and with appropriate distractions such as videos and mobiles.…”

Section: Discussionmentioning

confidence: 99%

The significance of inadequate transcranial Doppler studies in children with sickle cell disease

et al. 2017

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Sickle cell disease (SCD) is a common cause of cerebrovascular disease in childhood. Primary stroke prevention is effective using transcranial Doppler (TCD) scans to measure intracranial blood velocities, and regular blood transfusions or hydroxycarbamide when these are abnormal. Inadequate TCD scans occur when it is not possible to measure velocities in all the main arteries. We have investigated the prevalence and significance of this in a retrospective audit of 3915 TCD scans in 1191 children, performed between 2008 and 2015. 79% scans were normal, 6.4% conditional, 2.8% abnormal and 12% inadequate. 21.6% of 1191 patients had an inadequate scan at least once. The median age of first inadequate scan was 3.3 years (0.7–19.4), with a U-shaped frequency distribution with age: 28% aged 2–3 years, 3.5% age 10 years, 25% age 16 years. In young children reduced compliance was the main reason for inadequate TCDs, whereas in older children it was due to a poor temporal ultrasound window. The prevalence of inadequate TCD was 8% in the main Vascular Laboratory at King’s College Hospital and significantly higher at 16% in the outreach clinics (P<0.0001), probably due to the use of a portable ultrasound machine. Inadequate TCD scans were not associated with underlying cerebrovascular disease.

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Section: Discussionmentioning

confidence: 99%

The significance of inadequate transcranial Doppler studies in children with sickle cell disease

et al. 2017

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“…This finding is consistent with other studies demonstrating that TCD screening can be performed successfully in children younger than age 3 years. 20 , 21 The final TCD process included several effective TCD screening strategies supported in the literature (e.g., telephone support, scheduling TCDs to coincide with clinic visits). 22 , 23 However, this study differed in important ways.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Process for Initial Transcranial Doppler Ultrasonography in Children With Sickle Cell Anemia

Crosby

Joffe

Davis

et al. 2016

American Journal of Preventive Medicine

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Stroke, a devastating complication of sickle cell anemia (SCA), can cause irreversible brain injury with physical and cognitive deficits. Transcranial Doppler ultrasonography (TCD) is a non-invasive tool for identifying children with SCA at highest risk of stroke. National guidelines recommend that TCD screening begin at age 2 years, yet there is research to suggest less than half of young children undergo screening. The purpose of this project was to use quality improvement methods to improve the proportion of patients aged 24–27 months who successfully completed their initial TCD from 25% to 75% by December 31, 2013. Quality improvement methods (e.g., process mapping, simplified failure mode effect analysis, and plan–do–study–act cycles) were used to develop and test processes for identifying eligible patients, scheduling TCDs, preparing children and families for the first TCD, and monitoring outcomes (i.e., TCD protocol). Progress was tracked using a report of eligible patients and a chart showing the age in months for the first successful TCD (population metric). As of December 2013, 100% of eligible patients successfully completed their initial TCD screen; this improvement was maintained for the next 20 months. In November 2014, a Welch’s one-way ANOVA was conducted. Results showed a statistically significant difference between the average age of first TCD for eligible patients born in 2009 and eligible patients born during the intervention period (2010–2013; F[1,11.712]=16.03, p=0.002). Use of quality improvement methods to implement a TCD protocol was associated with improved TCD screening rates in young children with SCA.

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“…[32] Transcranial, ultrasound is used to detect children at high risk of cerebro-vascular accident especially among children below 2 years, and those found to be at high risk of stroke are given regular blood transfusions. [33] Prenatal diagnosis of sickle cell anaemia is the current method of diagnosis of SCD. Amniocentesis, chorionic villus sampling (CVS), and fetal blood sampling are used to obtain fetal cells for genetic diagnosis.…”

Section: Diagnosismentioning

confidence: 99%