Telfer Paul, Dwan Kerry, Simmons Andrea, Evanson Jane, Gadong Nimze, Newell Kim, Tangayi Sekayi, Leigh Andrea, Tsouana Eva, Hemmaway Claire, Kaya Banu
*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.
J Pediatr Hematol Oncol. 2016 Oct;38(7):517-24. doi: 10.1097/MPH.0000000000000633.
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.
在英国，经颅多普勒超声筛查儿童中风的风险尚不清楚。我们评估了一个由临床医生主导的项目，该项目使用了从STOP方案修改而来的风险评估方法。高风险分类包括大脑前动脉血流速度异常，以及初始血流速度>220 cm/s（高度异常）或之前至少有2次条件性扫描的单次异常扫描。总共对542名儿童进行了1653次扫描，随访了2235患者年。共识别出58名（10.7%）高风险受试者，其中18名（31%）高度异常，15名（26%）有过条件性扫描。2名（3%）受试者的血流速度异常仅局限于大脑前动脉。6岁前接受扫描的高风险儿童估计比例>20%。有4例急性缺血性中风（AIS）和2例急性出血性中风。所有中风、AIS和急性出血性中风的发病率分别为每100患者年0.27、0.18和0.09。高风险儿童的比例高于以往大多数估计，部分原因是我们修改了风险评估方法。每1000名接受经颅多普勒超声筛查的儿童中约有2名会进展为AIS。
