The number of children with a certain blood disorder undergoing an ultrasound to help prevent stroke is up significantly in the past 10 years since the publication of a major study showing its benefits. However, limited access to labs that perform this type of screening appears to be a barrier to helping these children who are at a high risk of stroke.
The research is published in the April 14, 2009, print issue of Neurology®, the medical journal of the American Academy of Neurology.
Researchers followed 157 children with sickle cell disease in northern California for an average of 8.5 years. Sickle cell disease is a lifelong blood disorder that increases a child's risk of stroke. Roughly one out of 10 children with the disease suffers a stroke by age 20.
For the study, researchers determined how many children underwent a transcranial Doppler ultrasound (TCD) screening since 1998, when a major study, known as the STOP trial, was published. The STOP trial showed a more than 90-percent reduction in the stroke rate of children with sickle cell disease who received a TCD screening and were identified as having a high risk of stroke and could therefore have blood transfusion therapy.
Since the STOP trial, the current study found the rate of TCD screening among children with sickle cell disease has increased six-fold while the annual stroke rate has dropped by more than half. However, researchers found children living farther away from a vascular laboratory were less likely to be screened.
"Stroke in children with sickle cell disease should be a largely preventable disease, however, not all children at risk are getting screened," said Heather J. Fullerton, MD, MAS, with the University of California, San Francisco. "Limited access to labs that perform TCD screening, even among kids with comprehensive health insurance, appears to be a barrier to helping these kids reduce their high risk of stroke. Increased availability of these screening labs may help prevent stroke in these high risk children."
Guidelines from the American Academy of Neurology recommend TCD screening of children with sickle cell disease beginning at age two.
The study was supported by a grant from the Thrasher Research Fund.
- Armstrong-Wells et al. Utilization of TCD screening for primary stroke prevention in children with sickle cell disease. Neurology, 2009; 72 (15): 1316 DOI: 10.1212/WNL.0b013e3181a110da
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