Evaluation of a comprehensive transcranial Doppler screening program for children with sickle cell anemia
Evaluation of a comprehensive transcranial Doppler screening program for children with sickle cell anemia
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DOI：
10.1002/pbc.21430
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发表时间：
2008-04-01
影响因子：
3.2
通讯作者：
Wang, Winfred
中科院分区：
文献类型：
--
作者：
McCarville, M. Beth;Goodin, Geoffrey S.;Wang, Winfred
背景：虽然经颅多普勒超声(TCD)筛查可以有效地识别具有卒中高危风险的镰状细胞性贫血(SCA)儿童，但并不是所有儿童都能得到筛查。2003年，我们制定了一项全面的TCD筛查计划，旨在筛查在我们的镰状细胞中心接受治疗的所有高危儿童。程序。我们通过比较每年筛查的患者数量和TCD使用定义的三个阶段的首次中风发生率来评估我们计划的有效性：(1)TCD筛查之前，(2)零星TCD筛查，(3)综合TCD筛查。结果。在第二阶段，平均每年筛查52名患者。在第三阶段，平均每年筛查95名患者，占高危人群的99%。第1期发生卒中18例，第2期22例，第3期3例。第3期首次卒中发生率明显低于第1期和第2期(P=0.047)。此外，在第2期和第3期的25名中风患者中，只有6人接受了TCD筛查(第2期有4人，第3期有2人)。这6人要么拒绝预防性输血治疗(n=2)，要么同时存在中风危险因素=2)，要么没有回来进行适当的TCD随访(n=2)。因此，中风的发生本身并不是TCD筛查失败的结果。结论。对大多数SCA儿童进行TCD筛查是可能的。TCD筛查在降低这些儿童的首次中风发生率方面是有效的。
Background Although transcranial Doppler ultrasonography (TCD) screening is effective in identifying children with sickle cell anemia (SCA) who are at high risk of stroke, not all children are screened. In 2003, we instituted a comprehensive TCD screening program designed to screen all at-risk children treated at our sickle cell center. Procedure. We evaluated the efficacy of our program by comparing the number of patients screened per year and incidence of first stroke across three periods defined by TCD usage: (1) predating TCD screening, (2) sporadic TCD screening, and (3) comprehensive TCD screening. Results. During Period 2, an average of 52 patients/year were screened. In Period 3, an average of 95 patients/year were screened representing 99% of the at-risk population. Eighteen strokes occurred in Period 1, 22 in Period 2 and three in Period 3. The first stroke incidence was significantly lower in Period 3 compared to Periods I and 2 (P=0.047). Furthermore, of the 25 patients in Periods 2 and 3 who had stroke, only six had received TCD screening (four in Period 2, two in Period 3). These six either declined prophylactic transfusion therapy (n=2), had co-existing stroke risk factors In = 2), or did not return for appropriate TCD follow-up (n=2). Therefore, strokes that occurred were not the result of a failure of TCD screening per se. Conclusions. It is possible to perform TCD screening of most children with SCA. TCD screening is effective in reducing first stroke incidence in these children.