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 and Stop II研究提供了第一个全面预防策略 I类证据支持的镰状细胞疾病。而TCD筛选的策略和 预防性输血对镰状细胞贫血的预防中风非常有效（停止 试验），即使在30或更多之后可以去除此疗法，也可以观察到高风险或中风 几个月的输血（停止II）尚不清楚这种方法在现实世界实践中的有效性 试验完成了。该项目利用了庞大的财务和人力资源 花费以获取停止和停止II数据及其结果数据库（可用于 调查人员）通过对医学进行深入分析，提供有关3400多名儿童的信息 在试验后的研究参与者的记录有关中风预防行为（重新筛查） 带有TCD和输血）和中风以及其他重要结果。两个结果是 最重要的兴趣：1）中风 - 在这方面是试验后发生的中风 筛选失败（没有TCD或时间不足或遵守筛查程序）或治疗 失败（尽管符合遵守 足够的输血）以及如何最好地使用此信息来改善中风预防 实践； 2）转换为高风险TCD。数据库包含初步（异常）TCD数据 关于超过3000名儿童和转换概率已从Stop发表 在小径期间进行筛选。假设在临床实践试验后的临床实践中有不同程度的纠正，并且 新异常确定了审判后；试验后模型是否预测了异常TCD的发生率 确认停止或与停止中观察到的内容有很大不同？无论哪种情况，审判后 经验将与停止数据相结合，以制定更强大的基于证据的临床准则 用于使用TCD进行筛查（如果第一个TCD未表明需要治疗）以确保足够 监视中风风险。停止和停止II是在专业的儿科SCD中心进行的 将研究向成人提供商系统过渡对预防中风的影响，态度 经过评估，这些数据用于为进一步的研究和教育提供信息。全面的 该项目提供了大量的新信息，可以确保停止的重大投资 停止II用于在现实世界应用中获得最大优势，以防止SCD儿童中风。

项目成果

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

• 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.