title: Transcranial Doppler Screening in a Regional Care Network for Sickle Cell Disease in the United Kingdom.
abstract: The risk of stroke in children screened with transcranial Doppler ultrasound in the United Kingdom is not known. We evaluated a clinician-led program using a risk assessment modified from the STOP protocol. High-risk classification included abnormal velocities in the anterior cerebral artery, and single abnormal scan if initial velocity >220 cm/s (high abnormal) or if preceded by at least 2 conditional scans. In total, 1653 scans were performed in 542 children, followed for 2235 patient-years. Fifty-eight (10.7%) high-risk subjects were identified, including 18 (31%) with high abnormal, and 15 (26%) with previous conditional scans. In 2 (3%), abnormal velocity was restricted to the anterior cerebral artery. The estimated proportion of children at high risk, scanned before 6 years of age was >20%. There were 4 cases of acute ischemic stroke (AIS) and 2 of acute hemorrhagic stroke. The incidence of all stroke, AIS, and acute hemorrhagic stroke were 0.27, 0.18, and 0.09 per 100 patient-years, respectively. The proportion of children at high risk is higher than most previous estimates, partly as a result of our modified risk assessment. About 2 children per 1000 screened with transcranial Doppler ultrasound progress to AIS.
authors.affiliation: *Center for Genomics and Child Health, Barts and The London School of Medicine, London †Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool Departments of ‡Pediatrics §Neuroradiology, Royal London Hospital, Barts Health NHS Trust, London ∥Department of Pediatrics, Newham University Hospital, Barts Health NHS Trust, London ¶Newham Sickle Cell and Thalassemia Community Centre, London #Department of Pediatrics, Whipps Cross University Hospital, Barts Health NHS Trust, London **Department of Pediatrics, Basildon University Hospital NHS Trust, Basildon, Essex ††Department of Hematology, Queens Hospital, Romford NHS Trust, Romford, Essex, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Telfer
authors.forename: Kerry
authors.initials: K
authors.lastname: Dwan
authors.forename: Andrea
authors.initials: A
authors.lastname: Simmons
authors.forename: Jane
authors.initials: J
authors.lastname: Evanson
authors.forename: Nimze
authors.initials: N
authors.lastname: Gadong
authors.forename: Kim
authors.initials: K
authors.lastname: Newell
authors.forename: Sekayi
authors.initials: S
authors.lastname: Tangayi
authors.forename: Andrea
authors.initials: A
authors.lastname: Leigh
authors.forename: Eva
authors.initials: E
authors.lastname: Tsouana
authors.forename: Claire
authors.initials: C
authors.lastname: Hemmaway
authors.forename: Banu
authors.initials: B
authors.lastname: Kaya
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D008297:Male; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*