Practice patterns for stroke prevention using transcranial Doppler in sickle cell anemia: DISPLACE Consortium.
clinical practice
prevention
sickle cell anemia
stroke
Journal
Pediatric blood & cancer
ISSN: 1545-5017
Titre abrégé: Pediatr Blood Cancer
Pays: United States
ID NLM: 101186624
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
11
11
2019
revised:
13
12
2019
accepted:
29
12
2019
pubmed:
12
1
2020
medline:
1
7
2020
entrez:
12
1
2020
Statut:
ppublish
Résumé
Children with sickle cell anemia (SCA) are at increased risk for stroke. In 2014, the National Heart, Lung, and Blood Institute (NHLBI) developed guidelines for stroke prevention in SCA informed by the Stroke Prevention Trial in Sickle Cell Anemia (STOP) and Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP II) trials. The guidelines specify the use of transcranial Doppler (TCD) screening and intervention with chronic red cell transfusions (CRCT) in children with SCA who have TCD indication of high stroke risk. The purpose of this study was to describe real-world practice patterns of stroke risk screening and intervention in sites that participated in the Dissemination and Implementation of Stroke Prevention Looking at the Care Environment (DISPLACE) Consortium. Site investigators completed a survey during the formative stages of the study to evaluate their TCD practices relative to the STOP studies. Descriptive statistics and analysis of free-text comments for more complex practices were evaluated. Results suggested universal acceptance of annual TCD screening and initiation of CRCT following an abnormal result among the DISPLACE Consortium, consistent with NHLBI recommendations. However, there was wide variation in methods for conducting TCD screenings (eg, dedicated Doppler vs TCD imaging), classifying TCD results, and actions taken for conditional and inadequate results. Annual TCD screening and initiation of CRCT are critical stroke prevention practices that were universally embraced in the consortium. Additional research would be beneficial for informing clinical practices for areas in which guidelines are absent or unclear.
Sections du résumé
BACKGROUND
Children with sickle cell anemia (SCA) are at increased risk for stroke. In 2014, the National Heart, Lung, and Blood Institute (NHLBI) developed guidelines for stroke prevention in SCA informed by the Stroke Prevention Trial in Sickle Cell Anemia (STOP) and Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP II) trials. The guidelines specify the use of transcranial Doppler (TCD) screening and intervention with chronic red cell transfusions (CRCT) in children with SCA who have TCD indication of high stroke risk. The purpose of this study was to describe real-world practice patterns of stroke risk screening and intervention in sites that participated in the Dissemination and Implementation of Stroke Prevention Looking at the Care Environment (DISPLACE) Consortium.
PROCEDURE
Site investigators completed a survey during the formative stages of the study to evaluate their TCD practices relative to the STOP studies. Descriptive statistics and analysis of free-text comments for more complex practices were evaluated.
RESULTS
Results suggested universal acceptance of annual TCD screening and initiation of CRCT following an abnormal result among the DISPLACE Consortium, consistent with NHLBI recommendations. However, there was wide variation in methods for conducting TCD screenings (eg, dedicated Doppler vs TCD imaging), classifying TCD results, and actions taken for conditional and inadequate results.
CONCLUSIONS
Annual TCD screening and initiation of CRCT are critical stroke prevention practices that were universally embraced in the consortium. Additional research would be beneficial for informing clinical practices for areas in which guidelines are absent or unclear.
Identifiants
pubmed: 31925913
doi: 10.1002/pbc.28172
pmc: PMC7036320
mid: NIHMS1066166
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e28172Subventions
Organisme : NINR NIH HHS
ID : K23 NR017899
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL133896
Pays : United States
Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
N Engl J Med. 2005 Dec 29;353(26):2769-78
pubmed: 16382063
AJR Am J Roentgenol. 2004 Oct;183(4):1117-22
pubmed: 15385317
AJNR Am J Neuroradiol. 2007 Sep;28(8):1613-8
pubmed: 17846223
Blood. 2016 Feb 18;127(7):829-38
pubmed: 26758917
Pediatr Hematol Oncol. 2010 Mar;27(2):69-89
pubmed: 20201689
Br J Haematol. 2008 Jul;142(1):94-9
pubmed: 18477038
Am J Hematol. 2016 Dec;91(12):1191-1194
pubmed: 27623561
Br J Haematol. 2006 Aug;134(3):333-9
pubmed: 16848777
N Engl J Med. 2014 Aug 21;371(8):699-710
pubmed: 25140956
Pediatr Radiol. 2005 Jan;35(1):66-72
pubmed: 15517239
Blood. 2004 May 15;103(10):3689-94
pubmed: 14751925
N Engl J Med. 1998 Jul 2;339(1):5-11
pubmed: 9647873
Am J Prev Med. 2010 Apr;38(4 Suppl):S512-21
pubmed: 20331952
PLoS One. 2017 Jul 25;12(7):e0181681
pubmed: 28742875
Pediatr Radiol. 2001 Jul;31(7):461-9
pubmed: 11486797
Lancet. 2016 Feb 13;387(10019):661-70
pubmed: 26670617
Pediatr Radiol. 2000 Nov;30(11):733-8
pubmed: 11100487
Expert Rev Hematol. 2013 Jun;6(3):301-16
pubmed: 23782084
Radiology. 2002 Mar;222(3):709-14
pubmed: 11867789
Blood. 1998 Jan 1;91(1):288-94
pubmed: 9414296