WEDNESDAY, April 15 (HealthDay News) -- Following the 1998 Stroke Prevention Trial in Sickle Cell Anemia, the rate of transcranial Doppler ultrasonography (TCD) screening rose steeply in a large health care plan, according to research published in the April 14 issue of Neurology.
Jennifer Armstrong-Wells, M.D., of the University of California in San Francisco, and colleagues analyzed data from a cohort of children with sickle cell disease from 1993 to 2005. The researchers assessed rates of first TCD screening over this period, as well as stroke incidence rates. The 1998 study linked transfusion therapy in children who were found to be at high risk of stroke with TCD screening with a much lower rate of stroke.
Before 1998, the average annual rate of TCD screening in 157 children was 1.8 per 100 person-years, the report indicates. This rate rose to 5.0 in 1998 through 1999, and 11.4 after 1999. The annualized stroke rate before first TCD was 0.44 per 100 person-years, and the rate post-TCD was 0.19. In multivariate analysis, the sole predictor of TCD screening was living near the vascular laboratory, the investigators found.
"TCD screening itself only stratifies stroke risk, but does not prevent stroke; stroke prevention depends on the implementation of chronic transfusion therapy. However, access to vascular laboratories appears to be a barrier to the implementation of this highly effective stroke prevention strategy, even among children with comprehensive health insurance. Increasing the availability of TCD screening may help prevent strokes in these extraordinarily high-risk children," the authors write.
A co-author disclosed financial relationships with a variety of pharmaceutical and other companies.
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