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Updated: Nov 27, 2025
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Recommendation to reality: Closing the transcranial Doppler screening gap for children with sickle cell anemia
Ashima Singh1, Vanaja Danda1, Laura Van Swol2
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
Insights
An electronic health record registry improved transcranial Doppler (TCD) screening adherence in children with sickle cell anemia (SCA). Child Life support further boosted TCD rates, ensuring better patient care.
Area of Science:
- Pediatric Hematology
- Medical Informatics
- Public Health
Background:
- Annual transcranial Doppler (TCD) screening is crucial for children with sickle cell anemia (SCA) but faces low compliance.
- Variability in TCD screening adherence poses a challenge to timely diagnosis and intervention in SCA patients.
- Improving TCD screening rates is essential for managing SCA complications.
Purpose of the Study:
- To implement and evaluate an electronic health record (EHR)-based registry to enhance TCD screening adherence in children with SCA.
- To identify and address barriers to TCD screening compliance in pediatric SCA patients.
- To leverage technology and support services for improved TCD screening outcomes.
Main Methods:
- Developed a real-time EHR-based registry for children with sickle cell disease (SCD) in 2016.
- Quarterly data extraction to monitor TCD rates and identify overdue patients.
- Integrated a TCD risk score and Child Life support for children under 7 years.
Main Results:
- Baseline TCD screening rate was 63%, increasing to 80% by Q3 2017.
- Sustained TCD screening rates above 70% after implementing Child Life support.
- Demonstrated significant improvement in TCD screening rates since 2015, meeting criteria for special cause variation.
Conclusions:
- EHR-based registries effectively improve and sustain TCD screening rates in pediatric SCA patients.
- Child Life support plays a vital role in enhancing TCD compliance, particularly in younger children.
- Systematic tracking and targeted interventions are key to optimizing TCD screening adherence in SCA.
Background:
Although annual transcranial Doppler (TCD) screening is recommended for children with sickle cell anemia (SCA), compliance is low and variable. Our objective was to utilize an electronic health record (EHR)-based registry to improve TCD adherence among children with SCA, 2-16 years of age, at our institution.
Methods:
We developed an in-EPIC real time registry for children with sickle cell disease in year 2016. Since end of year 2016, we have been extracting data quarterly to examine TCD rates and share the list of children who have not received a TCD screen in the past 18 months with the clinical team. The registry also includes a TCD risk score to enhance point of care. We also added Child Life support to increase TCD compliance among children <7 years. Control charts are used to examine TCD rates.
Results:
At baseline, prior to and start of quarterly data audit and feedback, 63% of children received the recommended annual TCD screen. TCD rates steadily increased to 80% by the third quarter of 2017. We observed a dip in TCD rates, driven by failure of screening young children. Since the initiation of Child Life support for children <7 years, we have sustained TCD screen rates >70%. Overall, our data meet criteria for special cause variation, indicating improvement in TCD rates since 2015.
Conclusions:
Regular tracking and identification of patients overdue for a TCD screen using an EHR-based registry resulted in sustained improvement in TCD screening rates. Involvement of Child Life support further improved TCD rates.
