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SACRED: Stroke Avoidance for Children in Republica Dominicana

Jeste, Neelum D, M.D.
http://orcid.org/0000-0002-8424-1375
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1495807669759263

Abstract Details

2017, MPH, University of Cincinnati, Medicine: Epidemiology.
Background: The Dominican Republic has a large burden of sickle cell disease, but many affected children lack access to preventative care and routine surveillance. Young children with sickle cell anemia (SCA) are at risk for stroke, a clinical even that leads to significant morbidity and mortality. In the United States, routine screening for stroke via Transcranial Doppler Ultrasound (TCD) is the standard of care and identifies children at highest risk, allowing for early intervention with blood transfusions or hydroxyurea. Additional clinical and laboratory variables, such as age, sex, level of anemia, medical history, or genetic variants, may confer predictive markers of stroke risk and allow for targeted screening in limited-resource settings. Methods: This prospective epidemiologic trial conducted by Cincinnati Children’s Hospital and Hospital Infantil Robert Reid Cabral in Santo Domingo consisted of a cross-sectional evaluation of TCD velocities in a cohort of children with SCA. Clinical and hematologic correlates were evaluated and genetic markers were analyzed on a subset of samples using dried blood spots. Data were collected using an internet-based REDCap&reg system with forms translated into Spanish. Results: 150 children enrolled in SACRED between July 18, 2016 and January 18, 2017. 105 (70%) children had a normal TCD velocity, while 35 (23%) had a conditional, 5 (3%) had an abnormal, and 5 (3%) had an inadequate TCD. Children with elevated TCDs were significantly younger and had lower height and weight compared to children with normal TCDs. Discussion: The results of SACRED provide novel epidemiologic data about the prevalence of children with SCA and stroke risk in the Dominican Republic. Children with higher risk were younger and smaller, and thus these children could be prioritized in a targeted screening approach in a limited-resource setting. The design and implementation of this trial reflect a successful international institutional partnership, one that featured local capacity building and training in research methods and clinical care. The trial’s results have important implications for screening and prevention of primary stroke in children with SCA living in resource-limited settings.
Susan Pinney, Ph.D. (Committee Chair)
Adam Lane (Committee Member)
Russell Ware (Committee Member)
76 p.
Epidemiology
sickle cell; stroke; Dominincan Republic; Transcranial Doppler

Recommended Citations

Citations

  • Jeste, M.D., N. D. (2017). SACRED: Stroke Avoidance for Children in Republica Dominicana [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1495807669759263

    APA Style (7th edition)

  • Jeste, M.D., Neelum. SACRED: Stroke Avoidance for Children in Republica Dominicana. 2017. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1495807669759263.

    MLA Style (8th edition)

  • Jeste, M.D., Neelum. "SACRED: Stroke Avoidance for Children in Republica Dominicana." Master's thesis, University of Cincinnati, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1495807669759263

    Chicago Manual of Style (17th edition)

ucin1495807669759263
367
© 2017, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.