McCarville M Beth, Goodin Geoffrey S, Fortner Gail, Li Chin-Shang, Smeltzer Matthew P, Adams Robert, Wang Winfred
Department of Radiological Sciences, St. Jude Children's Research Hospital, 332 North Lauderdale Street, Memphis, Tennessee 38105-2794, USA.
Pediatr Blood Cancer. 2008 Apr;50(4):818-21. doi: 10.1002/pbc.21430.
Although transcranial Doppler ultrasonography (TCD) screening is effective in identifying children with sickle cell anemia (SCA) who are at high risk of stroke, not all children are screened. In 2003, we instituted a comprehensive TCD screening program designed to screen all at-risk children treated at our sickle cell center.
We evaluated the efficacy of our program by comparing the number of patients screened per year and incidence of first stroke across three periods defined by TCD usage: (1) pre-dating TCD screening, (2) sporadic TCD screening, and (3) comprehensive TCD screening.
During Period 2, an average of 52 patients/year were screened. In Period 3, an average of 95 patients/year were screened representing 99% of the at-risk population. Eighteen strokes occurred in Period 1, 22 in Period 2 and three in Period 3. The first stroke incidence was significantly lower in Period 3 compared to Periods 1 and 2 (P = 0.047). Furthermore, of the 25 patients in Periods 2 and 3 who had stroke, only six had received TCD screening (four in Period 2, two in Period 3). These six either declined prophylactic transfusion therapy (n = 2), had co-existing stroke risk factors (n = 2), or did not return for appropriate TCD follow-up (n = 2). Therefore, strokes that occurred were not the result of a failure of TCD screening per se.
It is possible to perform TCD screening of most children with SCA. TCD screening is effective in reducing first stroke incidence in these children.
尽管经颅多普勒超声检查（TCD）筛查在识别镰状细胞贫血（SCA）中具有中风高风险的儿童方面是有效的，但并非所有儿童都接受了筛查。2003年，我们制定了一项全面的TCD筛查计划，旨在对在我们镰状细胞中心接受治疗的所有高危儿童进行筛查。
我们通过比较每年筛查的患者数量以及在由TCD使用情况定义的三个时期内首次中风的发生率，来评估我们计划的有效性：（1）TCD筛查之前，（2）零星TCD筛查，以及（3）全面TCD筛查。
在第2阶段，平均每年筛查52名患者。在第3阶段，平均每年筛查95名患者，占高危人群的99%。第1阶段发生了18次中风，第2阶段发生了22次，第3阶段发生了3次。与第1阶段和第2阶段相比，第3阶段的首次中风发生率显著更低（P = 0.047）。此外，在第2阶段和第3阶段发生中风的25名患者中，只有6人接受了TCD筛查（第2阶段4人，第3阶段2人）。这6人要么拒绝预防性输血治疗（n = 2），有并存的中风风险因素（n = 2），要么没有返回接受适当的TCD随访（n = 2）。因此，发生的中风并非TCD筛查本身失败的结果。
对大多数SCA儿童进行TCD筛查是可行的。TCD筛查在降低这些儿童的首次中风发生率方面是有效的。
