Transcranial Doppler Screening Adherence among Children with Sickle Cell Anemia Seen in the Emergency Department

Abstract

To evaluate adherence to annual transcranial Doppler ultrasound (TCD) screening to prevent stroke among patients with sickle cell anemia (SCA) seen in the emergency department (ED). This retrospective chart review included patients with SCA seen at a large pediatric ED over 64weeks. Patients who did not need a TCD (age <2 or ≥16years, on chronic transfusions, history of an inadequate TCD) or were not followed at the study institution were excluded. Patients who had received a TCD in the last 12months (TCD adherent) were compared with patients who had not (TCD nonadherent). During the study period, 257 patients with SCA in need of an annual TCD were identified and 63 patients (25%) had not received an annual TCD, including 19 patients (7%) who had never had a TCD. All TCD adherent patients had a clinic visit in the last year compared with 75% of TCD nonadherent patients, P<.0001. The mean interval time since the last hematology clinic appointment from the ED encounter was greater for the TCD nonadherent group: 70 vs 270days, P<.0001. Demographics including markers of socioeconomic status were not significantly different between the 2 groups. Patients with SCA who present to the ED and are nonadherent to TCD screening guidelines are less likely to have had a recent hematology clinic visit. Future interventions to improve screening for stroke in SCA should target this patient population seen in the ED but not clinic.