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Updated: Mar 30, 2026
Assessment of Cerebral Lateralization in Children using Functional Transcranial Doppler Ultrasound fTCD
Published on: September 27, 2010
Missed Opportunities for Transcranial Doppler Screening Among Children With Sickle Cell Disease
Sarah L Reeves1, Heather J Fullerton2, Lisa M Cohn3
1University of Michigan School of Public Health, Ann Arbor, MI, USA University of Michigan, Department of Pediatrics, Ann Arbor, MI, USA sleasure@umich.edu.
Insights
Low rates of transcranial Doppler (TCD) screening for children with sickle cell disease (SCD) were observed. Missed opportunities for TCD screening were frequent, highlighting a need for improved screening strategies in pediatric SCD care.
Area of Science:
- Pediatric Neurology
- Hematology
- Public Health
Background:
- Sickle cell disease (SCD) increases stroke risk in children.
- Transcranial Doppler (TCD) ultrasound is a key screening tool for identifying children with SCD at high risk for stroke.
- Current TCD screening rates in pediatric SCD populations are suboptimal.
Purpose of the Study:
- To evaluate TCD screening rates among children with SCD.
- To identify and analyze missed opportunities for TCD screening.
- To determine factors associated with missed TCD screening opportunities.
Main Methods:
- Retrospective analysis of administrative claims data for children (2-16 years) with SCD in Michigan Medicaid (2007-2011).
- Identified TCD screening receipt and "missed opportunities" (defined as ≥1 SCD-related outpatient visit without TCD screening).
- Used logistic regression with generalized estimating equations to assess correlates of missed opportunities.
Main Results:
- TCD screening rates remained low annually (10%-32%) across 1066 person-years.
- Missed opportunities for TCD screening occurred in 73% of person-years.
- Increasing age, prior TCD screening, and higher numbers of SCD-related outpatient visits were associated with missed opportunities.
Conclusions:
- A significant proportion of children with SCD experience missed opportunities for TCD screening.
- Addressing these missed opportunities presents a viable strategy to enhance overall TCD screening rates.
- Improved TCD screening protocols are crucial for stroke risk reduction in pediatric SCD.
Abstract:
Transcranial Doppler (TCD) screening rates remain low among children with sickle cell disease (SCD). We assessed TCD screening rates and missed opportunities for TCD screening. Children 2 to 16 years old with SCD enrolled in Michigan Medicaid for ≥1 year (2007-2011) were identified through newborn screening. Receipt of TCD screening and presence of a missed opportunity (≥1 SCD-related outpatient visit, no TCD screening) were identified through administrative claims. Potential correlates of missed opportunities included SCD-related health services, comorbidities, and demographics. Logistic regression with generalized estimating equations modeled associations between a missed opportunity and correlates. Overall, 353 children contributed 1066 person-years. TCD screening was low yearly (10%-32%); missed opportunities occurred in 73% of the person-years. Increasing age (odds ratio [OR] = 1.11; confidence interval CI = 1.07, 1.15), previous TCD screening (OR = 0.26; CI = 0.16, 0.41), and 4 to 5 (OR = 0.48; CI = 0.26, 0.87) or ≥6 outpatient visits (OR = 0.26; CI = 0.14, 0.49) were associated with a missed opportunity. Reduction of missed opportunities is a potential strategy to increase TCD screening rates.
