Limited Access to Ultrasound Impedes Efforts to Help Prevent Pediatric Stroke

The number of children with a specific blood disorder undergoing an ultrasound to help prevent stroke has increased significantly in the past 10 years since a major study demonstrated its benefits. However, limited access to labs that perform this type of screening appears to be an obstacle to helping these children who are at a high risk of stroke.

In the study, published in the April 14, 2009, issue of the journal Neurology, the researchers tracked 157 children with sickle cell disease in northern California (USA) for an average of 8.5 years. Sickle cell disease is a lifelong blood disorder that increases a child's risk of stroke. Approximately 1 child out of 10 with the disease suffers a stroke by age 20.

For the study, researchers determined how many children underwent a transcranial Doppler ultrasound (TCD) screening since 1998, when a key study, known as the STOP (Stroke Prevention Trial in Sickle Cell Anemia) trial, was published. The STOP trial revealed a more than 90% reduction in the stroke rate of children with sickle cell disease who received a TCD screening and were identified as having a high risk of stroke and could therefore have blood transfusion therapy.

Since the STOP trial, the current study found the rate of TCD screening among children with sickle cell disease has increased six-fold while the yearly stroke rate has decreased by more than half. However, researchers found children living farther away from a vascular laboratory were less likely to be screened. "Stroke in children with sickle cell disease should be a largely preventable disease, however, not all children at risk are getting screened," said Heather J. Fullerton, M.D., MAS, from the University of California, San Francisco (UCSF; USA). "Limited access to labs that perform TCD screening, even among kids with comprehensive health insurance, appears to be a barrier to helping these kids reduce their high risk of stroke. Increased availability of these screening labs may help prevent stroke in these high risk children."

Guidelines from the American Academy of Neurology (St. Paul, MN, USA) recommend TCD screening of children with sickle cell disease beginning at age two.

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University of California, San Francisco