Practice patterns for stroke prevention using transcranial Doppler in sickle cell anemia: DISPLACE Consortium
Practice patterns for stroke prevention using transcranial Doppler in sickle cell anemia: DISPLACE Consortium
复制标题
DOI：
10.1002/pbc.28172
复制
发表时间：
2020-01-11
影响因子：
3.2
通讯作者：
Kanter, Julie
中科院分区：
文献类型：
--
作者：
Schlenz, Alyssa M.;Phillips, Shannon;Kanter, Julie
背景 患有镰状细胞性贫血 (SCA) 的儿童中风的风险增加。 2014 年，国家心肺血液研究所 (NHLBI) 根据镰状细胞性贫血中风预防试验 (STOP) 和优化镰状细胞贫血中风初级预防 (STOP II) 试验制定了 SCA 中风预防指南。该指南规定了对经颅多普勒 (TCD) 筛查的使用以及对具有高卒中风险 TCD 指征的 SCA 儿童进行慢性红细胞输注 (CRCT) 干预。本研究的目的是描述参与中风预防护理环境 (DISPLACE) 联盟传播和实施的场所中中风风险筛查和干预的现实实践模式。程序 现场调查员在研究形成阶段完成了一项调查，以评估他们相对于 STOP 研究的 TCD 实践。对更复杂实践的自由文本评论的描述性统计和分析进行了评估。结果 结果表明 DISPLACE 联盟普遍接受年度 TCD 筛查并在结果异常后启动 CRCT，这与 NHLBI 的建议一致。然而，进行 TCD 筛查（例如，专用多普勒与 TCD 成像）、TCD 结果分类以及针对有条件和不充分结果采取的措施的方法存在很大差异。结论 年度 TCD 筛查和启动 CRCT 是重要的卒中预防措施，得到了该联盟的普遍认可。额外的研究将有助于为指南缺失或不清楚的领域的临床实践提供信息。
Background Children with sickle cell anemia (SCA) are at increased risk for stroke. In 2014, the National Heart, Lung, and Blood Institute (NHLBI) developed guidelines for stroke prevention in SCA informed by the Stroke Prevention Trial in Sickle Cell Anemia (STOP) and Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP II) trials. The guidelines specify the use of transcranial Doppler (TCD) screening and intervention with chronic red cell transfusions (CRCT) in children with SCA who have TCD indication of high stroke risk. The purpose of this study was to describe real-world practice patterns of stroke risk screening and intervention in sites that participated in the Dissemination and Implementation of Stroke Prevention Looking at the Care Environment (DISPLACE) Consortium. Procedure Site investigators completed a survey during the formative stages of the study to evaluate their TCD practices relative to the STOP studies. Descriptive statistics and analysis of free-text comments for more complex practices were evaluated. Results Results suggested universal acceptance of annual TCD screening and initiation of CRCT following an abnormal result among the DISPLACE Consortium, consistent with NHLBI recommendations. However, there was wide variation in methods for conducting TCD screenings (eg, dedicated Doppler vs TCD imaging), classifying TCD results, and actions taken for conditional and inadequate results. Conclusions Annual TCD screening and initiation of CRCT are critical stroke prevention practices that were universally embraced in the consortium. Additional research would be beneficial for informing clinical practices for areas in which guidelines are absent or unclear.