Stroke screening for SCA patients falls short

Results of a large retrospective study of children with sickle cell anemia (SCA) showed that many providers do not follow widely accepted recommendations for stroke risk screening. According to a protocol endorsed by the National Heart, Lung, and Blood Institute, children aged 2 to 16 years with SCA should have an annual transcranial Doppler ultrasound (TCD) to identify those at high risk of stroke because of elevated blood flow.

To ascertain TCD screening rates at 28 sites across the country, investigators analyzed data for 5116 children with SCA who were eligible for TCD implementation assessment for at least 1 of the 4 study years (2012- 2016). Rates varied widely, ranging from 30.9% to 74.7%. During the study period, 71.4% of patients had at least 1 TCD, whereas 28.6% did not have any. Among patients who should have had at least 4 TCDs, ac- cording to the guidelines, 18% had none. Investigators noted that these unsatisfactory screening rates exist in all areas of the country.

Thoughts from Dr. Farber

Although I am generally a proponent of reducing test use, this is an exception. You may be leaving the handling of your patients with sickle cell disease to a specialty clinic, but as a primary pediatrician, you should still check that the clinic is doing what needs to be done.

Reference

1. Kanter J, Phillips S, Schlenz AM, et al. Transcranial Doppler screening in a current cohort of children with sickle cell anemia: results from the DISPLACE. J Pediatr Hematol Oncol. 2021;43(8):e1062-e1067. doi:10.1097/MPH.0000000000002103