title: Risk of recurrent stroke in children with sickle cell disease receiving blood transfusion therapy for at least five years after initial stroke.
abstract: OBJECTIVE
  To test the hypothesis that children with sickle cell disease (SCD) who have an initial stroke temporally unrelated to another medical event are at higher risk for recurrent stroke than are children who had strokes temporally related to medical events.
  
  
  METHODS
  A retrospective cohort study of children with SCD and stroke who received regularly scheduled blood transfusions for a minimum of 5 years was conducted. Medical records were examined for the documentation of antecedent or concurrent medical events (hypertension, acute chest syndrome, aplastic crisis, fever associated with infection, exchange transfusion) associated with physician contact within 14 days before the initial stroke.
  
  
  RESULTS
  A total of 137 pediatric patients from 14 centers were studied. Mean age at first stroke was 6.3 years (1.4 to 14.0 years) with mean follow-up of 10.1 years (5 to 24 years). Thirty-one (22%) patients had a second stroke (2.2 per 100 patient years); 26 patients had an identified medical or concurrent event associated with their initial stroke. None of these patients had recurrent stroke 2 or more years after the initial event. The remaining 111 patients had an ongoing risk of recurrent stroke (1.9 per 100 patient-years) despite long-term transfusions (P =.038).
  
  
  CONCLUSIONS
  The absence of an antecedent or concurrent medical event associated with an initial stroke is a major risk factor for subsequent stroke while receiving regular transfusions.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Scothorn
authors.forename: Cynthia
authors.initials: C
authors.lastname: Price
authors.forename: Daniel
authors.initials: D
authors.lastname: Schwartz
authors.forename: Cindy
authors.initials: C
authors.lastname: Terrill
authors.forename: George R
authors.initials: GR
authors.lastname: Buchanan
authors.forename: Wanda
authors.initials: W
authors.lastname: Shurney
authors.forename: Ingrid
authors.initials: I
authors.lastname: Sarniak
authors.forename: Robert
authors.initials: R
authors.lastname: Fallon
authors.forename: Jen-Yih
authors.initials: JY
authors.lastname: Chu
authors.forename: Charles H
authors.initials: CH
authors.lastname: Pegelow
authors.forename: Winfred
authors.initials: W
authors.lastname: Wang
authors.forename: James F
authors.initials: JF
authors.lastname: Casella
authors.forename: Linda S
authors.initials: LS
authors.lastname: Resar
authors.forename: Brian
authors.initials: B
authors.lastname: Berman
authors.forename: Thomas
authors.initials: T
authors.lastname: Adamkiewicz
authors.forename: Lewis L
authors.initials: LL
authors.lastname: Hsu
authors.forename: Kwaku
authors.initials: K
authors.lastname: Ohene-Frempong
authors.forename: Kim
authors.initials: K
authors.lastname: Smith-Whitley
authors.forename: Donald
authors.initials: D
authors.lastname: Mahoney
authors.forename: J Paul
authors.initials: JP
authors.lastname: Scott
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Woods
authors.forename: Masayo
authors.initials: M
authors.lastname: Watanabe
authors.forename: Michael R
authors.initials: MR
authors.lastname: Debaun
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000628:therapy*; D001803:Blood Transfusion; D002648:Child; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*