Obstacles to primary stroke prevention in children with sickle cell disease.

摘要

Without prophylaxis, 1 in 10 children with sickle cell disease (SCD) has a stroke by age 20 years. Transcranial Doppler ultrasonography (TCD) can identify those at highest risk for stroke, and chronic blood transfusion therapy can decrease that risk by more than 90%. Despite the efficacy of this stroke prevention strategy, announced in a Clinical Alert by the National Heart, Lung, and Blood Institute in 1998, not all children with SCD receive TCD screening. We performed a nationwide survey of hematologists and vascular laboratories to identify perceived obstacles to TCD screening in stroke-free children with SCD.Methods. We surveyed all 1,056 US members of the American Society of Pediatric Hematology/Oncology (ASPH/O) and all 107 laboratories accredited for intracranial studies by the Intersocietal Commission for the Accreditation of Vascular Laboratories (http://www.intersocietal.org/icavl/Iaboratories/lab-s.htm). After obtaining IRB approval, anonymous surveys were mailed on a single occasion with self-reply envelopes. Summary statistics were calculated using STATA, version 9 (College Station, TX).Results. We received responses from 207 hematologists in 40 states (20% response rate); 68% practiced in large cities, and 56% in academic institutions. Select responses are shown in table; the remaining responses are in table E-l on the Neurology Web site at www.neurology.org. Respondents identified a median of one obstacle (mean 1.4; range 0 to 4) to obtaining TCD screening.