Transcranial Doppler Screening in a Current Cohort of Children With Sickle Cell Anemia: Results From the DISPLACE Study.
Transcranial Doppler Screening in a Current Cohort of Children With Sickle Cell Anemia: Results From the DISPLACE Study.
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DOI：
10.1097/mph.0000000000002103
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发表时间：
2021-11-01
期刊：
影响因子：
--
通讯作者：
Adams RJ
中科院分区：
文献类型：
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作者：
Kanter J;Phillips S;Schlenz AM;Mueller M;Dooley M;Sirline L;Nickel R;Brown RC;Hilliard L;Melvin CL;Adams RJ
镰状细胞性贫血 (SCA) 中风预防指南建议进行经颅多普勒 (TCD) 筛查，以识别有中风风险的儿童；然而，TCD 筛查实施情况仍然不佳。本报告介绍了 28 个地点的 DISPLACE（关注护理环境的中风预防传播和实施）研究的第 1 部分的结果，这是 TCD 实施率的基线评估。本报告按联盟站点特征描述了 TCD 实施情况；已完成的 TCD 的特点；以及基于年龄的 TCD 结果。该队列包括 5247 名患有 SCA 的儿童，其中 5116 名有资格接受至少一个研究年的 TCD 实施评估。大多数儿童是非裔美国人或黑人、非西班牙裔并接受医疗补助。首次记录 TCD 的平均年龄为 5.9 岁，研究结束时为 10.5 岁。各个地理区域观察到的 TCD 筛查率均不令人满意（平均 49.9%；范围 30.9-74.7%），与规模、机构类型或之前参与的卒中预防试验无关。 TCD 异常率为 2.9%，首次 TCD 结果异常的中位年龄为 6.3 岁。研究结果强调了现实世界的 TCD 筛查实践和迄今为止最大的 SCA 队列的结果。数据为改善中风筛查的第 3 部分实施研究提供了信息，研究结果可能为临床实践的改进提供信息。
Stroke prevention guidelines for sickle cell anemia (SCA) recommend transcranial Doppler (TCD) screening to identify children at stroke risk; however, TCD screening implementation remains poor. This report describes results from Part 1 of the 28-site DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) study, a baseline assessment of TCD implementation rates. This report describes TCD implementation by consortium site characteristics; characteristics of TCDs completed; and TCD results based on age. The cohort included 5247 children with SCA, of whom 5116 were eligible for TCD implementation assessment for at least one study year. The majority of children were African American or Black, non-Hispanic and received Medicaid. Mean age at first recorded TCD was 5.9 years and 10.5 years at study end. Observed TCD screening rates were unsatisfactory across geographic regions (mean 49.9%; range 30.9–74.7%) independent of size, institution type, or previous stroke prevention trial participation. The abnormal TCD rate was 2.9%, with a median age of 6.3 years for first abnormal TCD result. Findings highlight real-world TCD screening practices and results from the largest SCA cohort to date. Data informed the Part 3 implementation study for improving stroke screening and findings may inform clinical practice improvements.