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Obstacles to primary stroke prevention in children with sickle cell disease

Without prophylaxis, 1 in 10 children with sickle cell disease (SCD) has a stroke by age 20 years.1 Transcranial Doppler ultrasonography (TCD) can identify those at highest risk for stroke,2 and chronic blood transfusion therapy can decrease that risk by more than 90%.3 Despite the efficacy of this stroke prevention strategy, announced in a Clinical Alert by the National Heart, Lung, and Blood Institute in 1998, not all children with SCD receive TCD screening. We performed a nationwide survey of hematologists and vascular laboratories to identify perceived obstacles to TCD screening in stroke-free children with SCD.

We surveyed all 1,056 US members of the American Society of Pediatric Hematology/Oncology (ASPH/O) and all 107 laboratories accredited for intracranial studies by the Intersocietal Commission for the Accreditation of Vascular Laboratories (http://www.intersocietal.org/icavl/laboratories/labs.htm). After obtaining IRB approval, anonymous surveys were mailed on a single occasion with self-reply envelopes. Summary statistics were calculated using STATA, version …