Reeves Sarah L, Fullerton Heather J, Cohn Lisa M, Dombkowski Kevin J, Boulton Matthew L, Braun Thomas M, Lisabeth Lynda D
University of Michigan School of Public Health, Ann Arbor, MI, USA University of Michigan, Department of Pediatrics, Ann Arbor, MI, USA
University of California-San Francisco, Department of Neurology, CA, USA.
Clin Pediatr (Phila). 2016 Oct;55(12):1093-9. doi: 10.1177/0009922815614351. Epub 2015 Nov 4.
Transcranial Doppler (TCD) screening rates remain low among children with sickle cell disease (SCD). We assessed TCD screening rates and missed opportunities for TCD screening. Children 2 to 16 years old with SCD enrolled in Michigan Medicaid for ≥1 year (2007-2011) were identified through newborn screening. Receipt of TCD screening and presence of a missed opportunity (≥1 SCD-related outpatient visit, no TCD screening) were identified through administrative claims. Potential correlates of missed opportunities included SCD-related health services, comorbidities, and demographics. Logistic regression with generalized estimating equations modeled associations between a missed opportunity and correlates. Overall, 353 children contributed 1066 person-years. TCD screening was low yearly (10%-32%); missed opportunities occurred in 73% of the person-years. Increasing age (odds ratio [OR] = 1.11; confidence interval CI = 1.07, 1.15), previous TCD screening (OR = 0.26; CI = 0.16, 0.41), and 4 to 5 (OR = 0.48; CI = 0.26, 0.87) or ≥6 outpatient visits (OR = 0.26; CI = 0.14, 0.49) were associated with a missed opportunity. Reduction of missed opportunities is a potential strategy to increase TCD screening rates.
在镰状细胞病（SCD）患儿中，经颅多普勒（TCD）筛查率仍然很低。我们评估了TCD筛查率以及TCD筛查中错失的机会。通过新生儿筛查确定了2007年至2011年期间参加密歇根医疗补助计划≥1年的2至16岁SCD患儿。通过行政索赔确定是否接受了TCD筛查以及是否存在错失机会（≥1次与SCD相关的门诊就诊，未进行TCD筛查）。错失机会的潜在相关因素包括与SCD相关的医疗服务、合并症和人口统计学因素。采用广义估计方程的逻辑回归模型分析了错失机会与相关因素之间的关联。总体而言，353名儿童贡献了1066人年的数据。每年的TCD筛查率较低（10% - 32%）；73%的人年存在错失机会。年龄增长（比值比[OR] = 1.11；置信区间CI = 1.07, 1.15）、既往TCD筛查（OR = 0.26；CI = 0.16, 0.41）以及4至5次（OR = 0.48；CI = 0.26, 0.87）或≥6次门诊就诊（OR = 0.26；CI = 0.14, 0.49）与错失机会相关。减少错失机会是提高TCD筛查率的一种潜在策略。
