Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
Pediatr Blood Cancer. 2022 Feb;69(2):e29446. doi: 10.1002/pbc.29446. Epub 2021 Dec 2.
For decades, it has been recommended that children with sickle cell anemia (SCA) receive antibiotic prophylaxis to prevent serious infections and undergo transcranial Doppler (TCD) screening to identify those at highest risk of overt stroke. We assessed recent temporal trends in antibiotic prophylaxis prescription fills and TCD screening among children with SCA using validated quality measures.
Using validated claims-based definitions, we identified children with SCA who were enrolled in Michigan or New York State (NYS) Medicaid programs (2011-2018). Among recommended age groups, two outcomes were assessed yearly: (a) filling of ≥300 days of antibiotics, and (b) receipt of greater than or equal to one TCD. The proportion of children with each outcome was calculated by state. Temporal trends in each preventive service were assessed using generalized linear models.
A total of 1784 children were eligible for antibiotic prophylaxis (Michigan: 384; NYS: 1400), contributing 3322 person-years. Annual rates of filling ≥300 days of antibiotics ranged from 16% to 22% and were similar by state. There was no change in rates of antibiotic filling over time in Michigan (p-value: .10), but there was a decrease in NYS (p-value: .02). A total of 3439 children with SCA were eligible for TCD screening (Michigan: 710; NYS: 2729), contributing 10,012 person-years. Annual rates of TCD screening ranged from 39% to 45%, were similar by state, and did not change over time (p-values >.05).
Most children with SCA do not receive recommended antibiotic prophylaxis and/or TCD screening. New, sustainable, and coordinated interventions across preventive services are urgently needed.
几十年来，人们一直建议镰状细胞贫血（SCA）患儿接受抗生素预防治疗，以预防严重感染，并进行经颅多普勒（TCD）筛查，以确定那些有明显中风风险的患者。我们使用经过验证的质量指标评估了 SCA 患儿接受抗生素预防治疗和 TCD 筛查的最近时间趋势。
我们使用经过验证的基于索赔的定义，确定了参加密歇根州或纽约州（NYS）医疗补助计划（2011-2018 年）的 SCA 患儿。在推荐的年龄组中，每年评估两种结果：（a）服用≥300 天的抗生素；（b）接受大于或等于一次 TCD 检查。通过各州计算每种结果的儿童比例。使用广义线性模型评估每种预防服务的时间趋势。
共有 1784 名儿童有资格接受抗生素预防治疗（密歇根州：384 名；纽约州：1400 名），共计 3322 人年。每年服用≥300 天抗生素的比例为 16%至 22%，各州相似。密歇根州抗生素服用率没有随时间变化（p 值：.10），但纽约州有所下降（p 值：.02）。共有 3439 名 SCA 患儿有资格接受 TCD 筛查（密歇根州：710 名；纽约州：2729 名），共计 10012 人年。每年 TCD 筛查的比例为 39%至 45%，各州相似，且随时间无变化（p 值>.05）。
大多数 SCA 患儿未接受推荐的抗生素预防治疗和/或 TCD 筛查。迫切需要针对各种预防服务的新的、可持续的、协调的干预措施。
