Process for Improving Risk Assessment of Stroke in Sickle Cell Anemia Kids Developed by Researchers

Researchers developed a project using what are termed “quality improvement methods” to increase the number of sickle cell anemia (SCA) babies and toddlers between the ages of 24-27 months who undergo transcranial Doppler ultrasonography (TCD) to detect the risk of stroke. The findings show the intervention resulted in significantly improved TCD screening rates in young children with SCA.

The research paper, “Implementation of a Process for Initial Transcranial Doppler Ultrasonography in Children With Sickle Cell Anemia,” was published in the American Journal of Preventive Medicine.

According to certain studies, without proper intervention, about 10 percent of children with SCA will experience a stroke by the age of 20. Stroke, considered a complication of SCA, can result in serious and irreversible brain injury with physical and cognitive deficits. The highest incidence of stroke among SCA patients happens between the ages of 2 and 5 years. Therefore, there is a need to improve the availability and implementation of stroke prevention programs.

National SCA guidelines recommend transcranial Doppler ultrasonography (TCD) screening as early as 2 years old and continuing until age 16, because this non-invasive tool can identify SCA pediatric patients at the highest risk for stroke. Use of chronic blood transfusion therapy can then significantly reduce stroke risk in these children.

Despite the recommendations, recent research suggests that fewer than half of eligible young children undergo screening. Here, a quality improvement team aimed to develop a process for TCD screening consistent with national recommendations. The main objective was to increase the proportion of children with SCA who successfully completed their initial TCD from 25 percent (baseline) to 75 percent by December 31, 2013.

The quality improvement methods included process mapping, simplified failure mode effect analysis, and plan-do-study-act cycles. Such methods were used for identifying eligible patients, scheduling of TCDs, preparation of children and families for their first TCD, and analyses of outcomes.

Researchers tracked the progress using these measures and according to the findings, as of December 2013, 100 percent of the eligible patients successfully completed their initial TCD screening, an improvement that was maintained for the next 20 months. Also, the average age at initial TCD decreased from 33.2 to 25.0 months after the process was initiated.

“Although the direct causes for improvements (e.g., parent education versus follow-up phone call) were not examined, this study contributes to the limited literature on [quality improvements] in pediatric SCA and addresses a critical gap: the implementation of a TCD screening program for young children with SCA in a real-world setting,” the researchers concluded.