Optimizing Transcranial Doppler Screening for Stroke Prevention in Young African Children With Sickle Cell Disease

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Abstract
Background: The greatest burden of sickle cell disease (SCD) globally occurs in sub‐Saharan Africa, where significant morbidity occurs secondary to SCD‐induced vasculopathy and stroke. Transcranial doppler (TCD) ultrasound grades the severity of vasculopathy, with disease modifying therapy resulting in stroke risk reduction in high‐risk children. The feasibility and utility of TCD screening in young children with SCD remains understudied.Procedure: We performed a retrospective review of TCD examination results in children ≤24 months with SCD in one of six centers in Africa. Using the time‐averaged maximum of the mean flow velocity, values 200 cm/s high risk.Results: A total of 115 children were screened, with five (4.3%) unable to complete the TCD due to agitation. A total of 110 children with a mean age of 15 ± 5 months were included. Low risk studies were identified in 95 (86.4%) and conditional risk in 15 (13.6%). No patient had a high risk study. Those with conditional risk examinations were not more anemic than those with low risk studies (p = 0.84).Conclusions: TCD screening of young children with SCD is feasible, with low technical failure rates. Many children in our cohort had a conditional risk study, suggesting cerebral vasculopathy begins at a young age in some African children. Future large cohort studies should be undertaken to determine the incidence of conditional or high risk studies in African children ≤2 years with SCD to inform future guideline development for TCD screening.
Funding Information
  • National Institute of Child Health and Human Development
  • National Institutes of Health

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