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Blood, 15 May 2004, Vol. 103, No. 10, pp. 3689-3694.
Prepublished online as a Blood First Edition Paper on January 29, 2004; DOI 10.1182/blood-2003-08-2733.
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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Stroke and conversion to high risk in children screened with transcranial Doppler ultrasound during the STOP study
Robert J. Adams,
Donald J. Brambilla,
Suzanne Granger,
Dianne Gallagher,
Elliott Vichinsky,
Miguel R. Abboud,
Charles H. Pegelow,
Gerald Woods,
Elizabeth M. Rohde,
Fenwick T. Nichols,
Anne Jones,
Judith P. Luden,
Latonya Bowman,
Susan Hagner,
Knashawn H. Morales, and
E. Steve Roach, for the STOP Study Investigative Team
From the Department of Neurology, Medical College of Georgia, Augusta, GA; New England Research Institutes, Watertown, MA; Department of Hematology, Children's Hospital Oakland, Oakland, CA; Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC; Sickle Cell Center, University of Miami School of Medicine, Miami, FL; Section of Hematology/Oncology, Children's Mercy Hospital, Kansas City, MO; and Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC.
The Stroke Prevention Trial in Sickle Cell Anemia (STOP) was a randomized multicenter controlled trial comparing prophylactic blood transfusion with standard care in sickle cell anemia (SCA) children aged 2 to 16 years selected for high stroke risk by transcranial Doppler (TCD). More than 2000 children were screened with TCD to identify the 130 high-risk children who entered the randomized trial. A total of 5613 TCD studies from 2324 children were evaluated. We also collected information on stroke. We describe the changes in TCD with repeated testing and report the outcome without transfusion in the STOP screened cohort. Risk of stroke was higher with abnormal TCD than with normal or conditional TCD (P < .001) or inadequate TCD (P = .002), and risk with conditional TCD was higher than with normal TCD (P < .001). Repeated TCD in 1215 children showed that the condition of 9.4% of children became abnormal during observation. Younger patients and those with higher initial flow velocities were most likely to convert to abnormal TCDs. Screening in STOP confirmed the predictive value of TCD for stroke. Substantial differences in the probability of conversion to abnormal TCD were observed, with younger children and those with higher velocity more likely to have an abnormal TCD with rescreening.
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