Adherence to transcranial Doppler screening guidelines among children with sickle cell disease
Adherence to transcranial Doppler screening guidelines among children with sickle cell disease
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DOI：
10.1002/pbc.24240
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发表时间：
2013-02-01
影响因子：
3.2
通讯作者：
Cooper, William O.
中科院分区：
文献类型：
--
作者：
Eckrich, Michael J.;Wang, Winfred C.;Cooper, William O.
背景：对于建议每年使用经颅多普勒（TCD）超声检查重度镰状细胞病儿童卒中风险的指南的依从性知之甚少。目的是确定1997年至2008年期间接受推荐TCD筛查的216岁血红蛋白SS （HbSS）或镰状β 0-地中海贫血（HbS β 0）儿童的比例，并确定与依从性相关的因素。一项回顾性队列研究纳入了在田纳西州两家最大的镰状细胞中心接受治疗的HbSS或HbS β 0纳入田纳西州医疗补助计划的患者。关注的结果是遵守每年筛查TCD的指南，从计算机索赔中确定并通过医疗记录审查验证。使用KaplanMeier方法计算每年接受TCD的儿童的累积率。采用Cox比例风险回归来检验儿童、家庭和卫生保健使用特征与接受TCD的关系。结果在338例符合TCD条件的高危儿童中，232例（68.6%）在研究期间至少发生过一次TCD。年累积发病率由1997年的2.5%上升至2008年的68.3%。在多变量模型中，日历年、母亲教育程度和镰状细胞相关门诊就诊次数的增加与接受TCD的比率增加有关。结论：1997年至2008年间，接受公共保险的HbSS或HbS β 0患儿对TCD筛查指南的依从性增加，尽管31%在随访期间根本没有TCD。镰状细胞相关门诊就诊人数的增加与筛查指南的依从性增加有关。儿科血癌2013；60:270274。(c) 2012 Wiley期刊有限公司
Background Little is known about adherence to guidelines recommending yearly screening with transcranial Doppler (TCD) ultrasonography to detect stroke risk for children with severe sickle cell disease. The objective was to determine the proportion of children with hemoglobin SS (HbSS) or sickle-beta 0-thalassemia (HbS beta 0) aged 216 years who received recommended TCD screening from 1997 to 2008, and to identify factors associated with adherence. Procedure A retrospective cohort study included patients enrolled in Tennessee Medicaid with HbSS or HbS beta 0 who received care at the two largest sickle cell centers in Tennessee. The outcome of interest was adherence with guidelines for annual screening TCD's, identified from computer claims and validated through medical record review. The cumulative rate of children who received a TCD per year was calculated using the KaplanMeier method. Cox proportional hazards regression was used to examine the association of child, family, and health care use characteristics with receiving a TCD. Results Among 338 TCD eligible at-risk children, 232 (68.6%) had at least one TCD during the study period. The yearly cumulative incidence of annual TCD's increased from 2.5% in 1997 to 68.3% in 2008. In multivariate models, calendar year, maternal education, and increased number of sickle cell related outpatient visits were associated with an increased rate of receiving a TCD. Conclusions Publicly insured children with HbSS or HbS beta 0 had increasing adherence with TCD screening guidelines between 1997 and 2008, though 31% had no TCD at all during follow-up. Increasing number of sickle cell related outpatient visits was associated with increasing adherence to screening guidelines. Pediatr Blood Cancer 2013;60:270274. (c) 2012 Wiley Periodicals, Inc.