title: Stroke and conversion to high risk in children screened with transcranial Doppler ultrasound during the STOP study.
abstract: The Stroke Prevention Trial in Sickle Cell Anemia (STOP) was a randomized multicenter controlled trial comparing prophylactic blood transfusion with standard care in sickle cell anemia (SCA) children aged 2 to 16 years selected for high stroke risk by transcranial Doppler (TCD). More than 2000 children were screened with TCD to identify the 130 high-risk children who entered the randomized trial. A total of 5613 TCD studies from 2324 children were evaluated. We also collected information on stroke. We describe the changes in TCD with repeated testing and report the outcome without transfusion in the STOP screened cohort. Risk of stroke was higher with abnormal TCD than with normal or conditional TCD (P <.001) or inadequate TCD (P =.002), and risk with conditional TCD was higher than with normal TCD (P <.001). Repeated TCD in 1215 children showed that the condition of 9.4% of children became abnormal during observation. Younger patients and those with higher initial flow velocities were most likely to convert to abnormal TCDs. Screening in STOP confirmed the predictive value of TCD for stroke. Substantial differences in the probability of conversion to abnormal TCD were observed, with younger children and those with higher velocity more likely to have an abnormal TCD with rescreening.
authors.affiliation: Department of Neurology, Medical College of Georgia, Augusta, GA 30912-3200, USA. rjadams@mail.mcg.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adams
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Brambilla
authors.forename: Suzanne
authors.initials: S
authors.lastname: Granger
authors.forename: Dianne
authors.initials: D
authors.lastname: Gallagher
authors.forename: Elliott
authors.initials: E
authors.lastname: Vichinsky
authors.forename: Miguel R
authors.initials: MR
authors.lastname: Abboud
authors.forename: Charles H
authors.initials: CH
authors.lastname: Pegelow
authors.forename: Gerald
authors.initials: G
authors.lastname: Woods
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Rohde
authors.forename: Fenwick T
authors.initials: FT
authors.lastname: Nichols
authors.forename: Anne
authors.initials: A
authors.lastname: Jones
authors.forename: Judith P
authors.initials: JP
authors.lastname: Luden
authors.forename: Latonya
authors.initials: L
authors.lastname: Bowman
authors.forename: Susan
authors.initials: S
authors.lastname: Hagner
authors.forename: Knashawn H
authors.initials: KH
authors.lastname: Morales
authors.forename: E Steve
authors.initials: ES
authors.lastname: Roach
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000628:therapy; D001783:Blood Flow Velocity; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D011237:Predictive Value of Tests; D011336:Probability; D012306:Risk; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial