Opportunities to Improve Transcranial Doppler Screening Among Children With Sickle Cell Disease.

Pediatric Stroke;Sickle Cell Disease;Public Health;Health Sciences;Epidemiological Science

Reeves, Sarah Erin LeasureBoulton, Matthew L. ;

University of Michigan

关键词: Pediatric Stroke;    Sickle Cell Disease;    Public Health;    Health Sciences;    Epidemiological Science;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/102487/sleasure_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

Children with sickle cell disease (SCD) are at an increased risk of stroke. Transcranial Doppler (TCD) screening assesses the risk of stroke in children with SCD by measuring blood velocity in cerebral vessels. High velocities are strongly associated with stroke risk and indicate the need to begin chronic blood transfusions as a stroke prevention strategy. Although chronic blood transfusions have been known to reduce stroke risk by up to 92% since the nineties, rates of TCD screening remain low and few factors have been identified that are associated with receipt of TCD screening. This dissertation investigated factors that may influence receipt of TCD screening among children with SCD on multiple levels by 1) assessing TCD screening rates and frequency and predictors of missed opportunities among children with SCD in Michigan Medicaid, 2) exploring the role of neighborhood factors in receipt of TCD screening among children with SCD in Michigan Medicaid residing in Wayne County, and 3) investigating physician awareness, attitudes and knowledge of TCD screening guidelines, along with physician perceived barriers to screening.Assessment of TCD screening rates and missed opportunities in children with SCD enrolled in Michigan Medicaid showed that TCD screening rates were low, particularly among adolescents. Low TCD rates coupled with high healthcare utilization resulted in frequent missed opportunities for TCD screening. Increasing age was associated with an increased likelihood for a missed opportunity, while more than 4 outpatient visits and previous receipt of TCD screening decreased the odds for a missed opportunity. No association was found between receipt of TCD screening and socio-demographic characteristics of the child’s neighborhood, nor was any spatial pattern of screening rates discovered across neighborhoods. Although physicians believed that children with SCD should receive TCD, significant differences existed in awareness, attitudes and knowledge of TCD screening guidelines across specialties, and knowledge of specific TCD recommendations was low for all physicians. The culmination of this work suggests that future studies and interventions are necessary to continue to identify and intervene on factors associated with TCD screening among children with SCD to avert the consequences of stroke in this high-risk population.