Personalized Reminders Increase Screening for Stroke Risk in Children with Sickle Cell Anemia

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Transcranial Doppler ultrasound (TCD) effectively identifies children with sickle cell anemia (SCA) who are at increased risk of stroke. We evaluated a low-cost quality improvement (QI) intervention to increase the proportion of children screened by TCD.


We measured the proportion of children with SCA receiving appropriate TCD screening for increased cerebral blood velocity, a marker of stroke risk, for time periods before (April 1, 2009–July 1, 2010) and after (October 1, 2010–January 1, 2012) the implementation of a QI program. We sent eligible families personalized reminder letters, information on screening, and a refrigerator magnet imprinted with the recommended date of TCD screening.


Only 54% (60/112) of children (median age 8 years, range 2.2–16.7 years) had a TCD in the baseline period compared with 79% (87/110; P = 0.0001) after implementation of the QI initiative. The odds of appropriate TCD screening decreased with older age in the baseline period (odds ratio 0.86, 95% confidence interval 0.78–0.94/year; P = 0.001), but not after implementation. Neither predicted travel time by car (median 20 minutes, range 2–164) nor distance traveled (median 9.7 mi, range 0.4–132) was significantly associated with appropriate TCD screening before or after QI implementation. The number needed to treat was four.


We demonstrated the feasibility and effectiveness of a low-cost QI intervention to increase TCD screening. This approach was more successful than other related intervention models and is easily implemented by smaller sickle cell programs without full-time personnel.

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