Transcranial Doppler Ultrasound for Primary Stroke Prevention in Sickle Cell Disease

About 10% of children with sickle cell disease (SCD) have a stroke by age 20. Chronic blood transfusion, used widely for secondary stroke prevention in these patients, is not widely employed for primary prevention because of cost and adverse effects. In 1998, the Stroke Prevention Trial in Sickle Cell Anemia (STOP) showed that transcranial Doppler ultrasound (TCD) can help clinicians identify children at high risk for first ischemic stroke, allowing targeted transfusion therapy for primary prevention. To examine utilization rates and barriers to TCD screening, researchers retrospectively identified all children (up to age 20) with SCD enrolled in a large health maintenance organization (HMO) from 1993 through 2005. The authors extracted cli…