Prevention of Stroke after STOP, A Retrospective Chart Review

停止后预防中风，回顾性图表回顾

• 批准号: 8292038
• 负责人: ROBERT J ADAMS
• 金额: $ 62.42万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2015-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8292038
• 关键词: Adult; Area; Attitude; Behavior; Brain Infarction; Child; Childhood; Clinical; Clinical Trials; Data; Databases; Diagnosis; Education; Enrollment; Event; Failure; Frequencies; Goals; Guidelines; Human Resources; Incidence; Infarction; Investigation; Investments; Medical Records; Modeling; Outcome; Participant; Patients; Persons; Phase; Prevention strategy; Probability; Protocols documentation; Provider; Publishing; Quality of Care; Recommendation; Research; Research Personnel; Risk; Screening Result; Screening procedure; Sickle Cell Anemia; Stroke; Stroke prevention; Symptoms; System; Testing; Time; Transfusion; Transient Ischemic Attack; Treatment Failure; Validation; abstracting; base; care systems; cerebrovascular; clinical practice; cohort; evidence base; experience; high risk; improved; insight; interest; prevent; programs; prophylactic; real world application; trial comparing; young adult

Project Abstract The STOP and STOP II studies provided the first comprehensive stroke prevention strategy in Sickle Cell Disease supported by Class I evidence. While the strategy of TCD screening and prophylactic transfusion was very efficacious in the Stroke Prevention in Sickle Cell Anemia (STOP trial), and reversion to high risk or stroke was observed if this therapy is removed even after 30 or more months of transfusion (STOP II) it is unclear how effective this approach is in real world practice after the trials were completed. This project leverages the enormous financial and human resources expended to obtain STOP and STOP II data, and their resulting data bases (available to the investigators) with information on over 3400 children, by making an in-depth analysis of the medical records of study participants in the post trial period regarding stroke prevention behaviors (re-screening with TCD and transfusion) and stroke as well as other important outcomes. Two outcomes are of paramount interest: 1) stroke - in this respect were the strokes that took place after the trial the result of screening failures (no TCD or inadequate timing or compliance with screening programs) or treatment failures (transfusion not recommended or accepted or breakthrough stroke despite compliance with adequate transfusion) and how can this information be best used to improve stroke prevention practices; 2) conversion to high risk TCD. The data bases contain preliminary (pre abnormal) TCD data on over 3000 children, and probabilities for conversion have been published from STOP based on rescreening during the trail. Assuming varying degrees of rescreening in clinical practice post trial, and new abnormals identified post trial; does the post trial model predicting the incidence of abnormal TCD confirm STOP or vary substantially from what was observed in STOP? In either case post trial experience will be combined with STOP data to formulate stronger evidence based clinical guidelines for re screening with TCD (if the first TCD does not indicate need for treatment) to insure adequate surveillance for stroke risk. STOP and STOP II were carried out in specialized pediatric SCD centers, the impact of transition to adult provider systems on stroke prevention will be studied, attitudes assessed and these data used to inform recommendations for further research and education. Overall the project provides substantial new information that will insure the major investment made in STOP and STOP II is used to best advantage in real world applications to prevent stroke in children with SCD.

项目摘要 STOP和STOP II研究提供了第一个全面的中风预防策略 由I类证据支持的镰状细胞病。而TCD筛查和治疗的策略 预防性输血预防镰状细胞性贫血(Stop)卒中有效 试验)，并观察到即使在30年或更长时间后取消这种治疗，也会恢复到高风险或中风 几个月的输血(停止II)不清楚这种方法在现实世界的实践中有多有效 试验已经完成。这一项目利用了巨大的财力和人力资源 用于获得STOP和STOP II数据及其产生的数据库(可用于 调查人员)拥有超过3400名儿童的信息，通过深入分析 试验后研究参与者关于卒中预防行为的记录(重新筛查 TCD和输血)和中风以及其他重要后果。两个结果是 最感兴趣的是：1)中风-在这方面，中风是在审判后发生的中风的结果 筛查失败(没有TCD或时机不充分或符合筛查计划)或治疗 失败(不建议或接受输血或突破性中风，尽管遵守 充分输血)，以及如何最好地利用这些信息来改善中风的预防 2)向高危TCD转变。数据库包含初步(异常前)TCD数据 关于3000多名儿童的数据，并根据Stop发布了转换的概率 在追踪过程中重新筛选。假设在试验后的临床实践中进行不同程度的再筛选，以及 试验后发现新的异常；试验后模型是否预测异常TCD的发生率 确认停止还是与停止中观察到的有很大不同？在任何一种情况下，都要在审判后 经验将与STOP数据相结合，以制定更有力的循证临床指南 用TCD重新筛查(如果第一次TCD没有表明需要治疗)，以确保足够的 监测中风风险。STOP和STOP II在专门的儿科SCD中心进行， 将研究向成人提供者系统过渡对中风预防的影响，态度 评估并利用这些数据为进一步研究和教育提供建议。总括 该项目提供了大量的新信息，将确保在Stop进行的主要投资 而Stop II在现实世界中用于预防SCD儿童中风的应用程序是最有优势的。

项目成果

Transcranial doppler re-screening of subjects who participated in STOP and STOP II.

经常参与Stop and Stop II的受试者的经颅多普勒重新筛选。

• DOI: 10.1002/ajh.24551
• 发表时间: 2016-12
• 期刊: AMERICAN JOURNAL OF HEMATOLOGY
• 影响因子: 12.8
• 作者: Adams, Robert J.;Lackland, Dan T.;Brown, Lynette;Brown, David;Voeks, Jenifer;Fullerton, Heather J.;Kanter, Julie;Kwiatkowski, Janet L.
• 通讯作者: Kwiatkowski, Janet L.