DISPLACE study shows poor quality of transcranial doppler ultrasound for stroke risk screening in sickle cell anemia.

Autor:	Davidow KA; Department of Pediatrics, Lisa Dean Moseley Foundation Institute for Cancer and Blood Disorders, Nemours Children's Hospital, Delaware, Wilmington, DE., Miller RE; Department of Pediatrics, Lisa Dean Moseley Foundation Institute for Cancer and Blood Disorders, Nemours Children's Hospital, Delaware, Wilmington, DE., Phillips SM; College of Nursing, Medical University of South Carolina, Charleston, SC., Schlenz AM; Department of Pediatrics, Medical University of South Carolina, Charleston, SC.; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO., Mueller M; College of Nursing, Medical University of South Carolina, Charleston, SC.; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC., Hulbert ML; Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO., Hsu LL; Division of Pediatric Hematology/Oncology, University of Illinois at Chicago, Chicago, IL., Bhasin N; Division of Hematology, Department of Pediatrics, University of California, San Francisco, Oakland, CA., Adams RJ; Department of Neurology, Medical University of South Carolina, Charleston, SC., Kanter J; Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL.
Jazyk:	angličtina
Zdroj:	Blood advances [Blood Adv] 2024 Jul 09; Vol. 8 (13), pp. 3444-3452.
DOI:	10.1182/bloodadvances.2024012631
Abstrakt:	Abstract: Children with sickle cell anemia (SCA) are at increased risk of stroke when compared with their age-based counterparts. The Stroke Prevention Trial in Sickle Cell Anemia (STOP) previously demonstrated that with the use of transcranial Doppler ultrasound (TCD; Sickle Stroke Screen) and chronic red cell transfusion, the risk of stroke is reduced by over 90%. The STOP criteria detailed the type and method of measurement required; the time-averaged mean maximum velocity (TAMMV). Unfortunately, it has been difficult to adhere to the appropriate TAMMV measurements. The objectives of this study were to assess the quality of TCD and transcranial Doppler imaging (TCDi) reports to determine the report quality and accuracy. This is a subanalysis of the DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) study. Over 12 000 TCD/TCDi reports were collected during this study from 28 institutions; 391 TCDs were reviewed for this subanalysis. There were significant variations in the vessels being assessed, the velocities used to define abnormal results, and who was interpreting the scans. In 52% of reports, it was impossible to identify whether the TAMMV was what was measured. Similarly, it was only clear in 42% of reports that the TAMMV was used to interpret the examination as normal/abnormal. Given this inconsistency, we strongly recommend standardization of TCD/TCDi reporting, specialized training for those performing and interpreting the scans in the use of TCD/TCDi in patients with SCA, internal quality assurance, and institutional quality improvement work to ensure appropriate use of this potentially lifesaving technology. (© 2024 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)
Databáze:	MEDLINE
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