Transcranial Doppler Ultrasonography and Prophylactic Transfusion Program Is Effective in Preventing Overt Stroke in Children with Sickle Cell Disease

• Published in: The Journal of pediatrics 2010-09, Vol.157 (3), p.479-484
• Main Authors: Enninful-Eghan, Henrietta, MPH, Moore, Reneé H., PhD, Ichord, Rebecca, MD, Smith-Whitley, Kim, MD, Kwiatkowski, Janet L., MD, MSCE
• Format: Article
• Language: English
• Subjects: Adolescent; Anemia, Sickle Cell - complications; Arteries; Biological and medical sciences; Blood Transfusion; Cardiovascular system; Child; Child, Preschool; Female; General aspects; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Pediatrics; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Stroke - diagnostic imaging; Stroke - prevention & control; Ultrasonic investigative techniques; Ultrasonography, Doppler, Transcranial
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2010.03.007

Objective To assess the impact of our transcranial Doppler ultrasonography (TCD) program on the incidence of first stroke and the rate of transfusion for stroke prevention in children with sickle cell disease. Study design In this single-institution, retrospective study, we compared the incidence of stroke and of transfusion for stroke prevention in 475 patients observed in the 8-year period before instituting TCD screening with the rate in 530 children in the 8-year period after. Results The incidence of overt stroke in the pre-TCD period was 0.67 per 100 patient-years, compared with 0.06 per 100 patient-years in the post-TCD period ( P < .0001). Of the 2 strokes in the post-TCD period, 1 occurred in a child too young for the screening protocol, and 1 occurred in a child with high velocities solely in the anterior cerebral arteries. The rate of transfusion therapy for stroke prevention increased from 0.67 per 100 patient-years to 1.12 per 100 patient-years since instituting our program ( P = .008). Conclusions Our program has been successful in reducing the rate of first overt stroke, but with increased use of transfusion. Additional modifications to screening might further reduce the risk of first stroke, and studies of alternative treatments may be beneficial.