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Adherence to transcranial Doppler screening guidelines among children with sickle cell disease
Michael J Eckrich1, Winfred C Wang, Elizabeth Yang
1Center for International Blood and Marrow Transplant Research (CIBMTR), Milwaukee, Wisconsin, USA.
Insights
Adherence to yearly transcranial Doppler (TCD) screening for children with sickle cell disease (SCD) increased significantly from 1997 to 2008. More outpatient visits for SCD correlated with higher screening adherence.
Area of Science:
- Pediatric Hematology
- Neurology
- Medical Ultrasound
Background:
- Adherence to annual transcranial Doppler (TCD) ultrasonography screening for stroke risk in children with severe sickle cell disease (SCD) is not well understood.
- Guidelines recommend yearly TCD screening for children with hemoglobin SS (HbSS) or sickle-β(0)-thalassemia (HbSβ(0)).
Purpose of the Study:
- To determine the proportion of children with HbSS or HbSβ(0) aged 2-16 years who received recommended TCD screening between 1997 and 2008.
- To identify factors associated with adherence to TCD screening guidelines.
Main Methods:
- Retrospective cohort study of Tennessee Medicaid patients with HbSS or HbSβ(0) at two major sickle cell centers.
- Adherence to annual TCD screening was identified via claims data and medical record review.
- Kaplan-Meier method calculated cumulative TCD incidence; Cox regression analyzed associated factors.
Main Results:
- Of 338 eligible children, 68.6% received at least one TCD during the study period.
- Yearly cumulative incidence of TCD screening increased from 2.5% in 1997 to 68.3% in 2008.
- Calendar year, maternal education, and increased outpatient visits for SCD were associated with higher TCD screening rates.
Conclusions:
- Adherence to TCD screening guidelines improved for publicly insured children with HbSS or HbSβ(0) from 1997-2008, but 31% remained unscreened.
- Increased outpatient visits for SCD correlated with greater adherence to recommended TCD screening.
Background:
Little is known about adherence to guidelines recommending yearly screening with transcranial Doppler (TCD) ultrasonography to detect stroke risk for children with severe sickle cell disease. The objective was to determine the proportion of children with hemoglobin SS (HbSS) or sickle-β(0) -thalassemia (HbSβ(0) ) aged 2-16 years who received recommended TCD screening from 1997 to 2008, and to identify factors associated with adherence.
Procedure:
A retrospective cohort study included patients enrolled in Tennessee Medicaid with HbSS or HbSβ(0) who received care at the two largest sickle cell centers in Tennessee. The outcome of interest was adherence with guidelines for annual screening TCD's, identified from computer claims and validated through medical record review. The cumulative rate of children who received a TCD per year was calculated using the Kaplan-Meier method. Cox proportional hazards regression was used to examine the association of child, family, and health care use characteristics with receiving a TCD.
Results:
Among 338 TCD eligible at-risk children, 232 (68.6%) had at least one TCD during the study period. The yearly cumulative incidence of annual TCD's increased from 2.5% in 1997 to 68.3% in 2008. In multivariate models, calendar year, maternal education, and increased number of sickle cell related outpatient visits were associated with an increased rate of receiving a TCD.
Conclusions:
Publicly insured children with HbSS or HbSβ(0) had increasing adherence with TCD screening guidelines between 1997 and 2008, though 31% had no TCD at all during follow-up. Increasing number of sickle cell related outpatient visits was associated with increasing adherence to screening guidelines.
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