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Updated: Nov 16, 2025
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Transcranial Doppler Screening in a Current Cohort of Children With Sickle Cell Anemia: Results From the DISPLACE
Julie Kanter1, Shannon Phillips2, Alyssa M Schlenz3
1Division of Hematology and Oncology, University of Alabama Birmingham, Birmingham, AL.
Insights
Stroke prevention guidelines recommend transcranial Doppler (TCD) for children with sickle cell anemia (SCA), but implementation is poor. This study found low TCD screening rates, highlighting a critical gap in stroke risk identification for SCA patients.
Area of Science:
- Pediatric Hematology
- Neurology
- Public Health
Background:
- Stroke is a major complication in sickle cell anemia (SCA).
- Transcranial Doppler (TCD) screening identifies children at high risk for stroke.
- Current TCD screening implementation in SCA is suboptimal.
Purpose of the Study:
- To assess baseline TCD screening implementation rates in a large cohort of children with SCA.
- To identify factors influencing TCD implementation and report TCD results.
- To inform strategies for improving stroke prevention in SCA.
Main Methods:
- Analysis of data from Part 1 of the DISPLACE study, a 28-site assessment.
- Inclusion of 5116 children with SCA eligible for TCD assessment.
- Evaluation of TCD screening rates, characteristics, and results by age and site demographics.
Main Results:
- Overall TCD screening rates were unsatisfactory, averaging 49.9% across sites.
- Screening rates varied by region but were independent of site characteristics.
- An abnormal TCD rate of 2.9% was observed, with a median age of 6.3 years for the first abnormal result.
Conclusions:
- Real-world TCD screening practices for SCA patients show significant implementation gaps.
- Findings from this large cohort provide critical data for improving stroke screening protocols.
- The results underscore the need for enhanced clinical practice to improve stroke prevention in children with SCA.
Abstract:
Stroke prevention guidelines for sickle cell anemia (SCA) recommend transcranial Doppler (TCD) screening to identify children at stroke risk; however, TCD screening implementation remains poor. This report describes results from Part 1 of the 28-site DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) study, a baseline assessment of TCD implementation rates. This report describes TCD implementation by consortium site characteristics; characteristics of TCDs completed; and TCD results based on age. The cohort included 5247 children with SCA, of whom 5116 were eligible for TCD implementation assessment for at least 1 study year. The majority of children were African American or Black, non-Hispanic and received Medicaid. Mean age at first recorded TCD was 5.9 and 10.5 years at study end. Observed TCD screening rates were unsatisfactory across geographic regions (mean 49.9%; range: 30.9% to 74.7%) independent of size, institution type, or previous stroke prevention trial participation. The abnormal TCD rate was 2.9%, with a median age of 6.3 years for first abnormal TCD result. Findings highlight real-world TCD screening practices and results from the largest SCA cohort to date. Data informed the part 3 implementation study for improving stroke screening and findings may inform clinical practice improvements.
