Kudos to PhD student La’Kita Knight (and her sponsor Paula Tanabe, associate dean for research development and data science) for the submission of her NIH NRSA Individual Predoctoral Fellowship to Promote Diversity in Health-Related Research (F31) application entitled “Transcranial Doppler Screenings and Associated Risk Factors in Children ages 2 to 16 years old with Sickle Cell Disease on North Carolina Medicaid.” This proposal requests funding for a 2.5-year period with a start date of July 1, 2020.

Background: Sickle cell disease (SCD) is the most common inherited abnormal blood disease in the United States. Prevalence of stroke in children with SCD is 10%. Strokes are a common complication in SCD and the risk begins as early as infancy. Transcranial Doppler (TCD) screenings can identify specific children with SCD who are at risk for developing a stroke. Yearly TCD screenings are strongly recommended by the National Heart, Lung, and Blood Institute (NHLBI) beginning at age 2 years through 16 years of age for children with SCD. Critical knowledge gaps remain around the prevalence, incidence, and compliance rates of early screening in SCD as well as variation in who is being screened in North Carolina (NC). This study will focus on children with SCD who are Medicaid beneficiaries within the entire state of NC as this population is an at-risk group for poorer health status. We will investigate age, as school aged children are more likely to experience cognitive decline as symptoms are typically noticed in elementary school. Additionally, we will examine healthcare providers, as there is uncertainty concerning their TCD ordering practices. This project proposes a longitudinal analysis of TCD screening prevalence, incidence, and compliance rates in a cohort of children with SCD.

The specific aims are:

#1: To determine the prevalence and incidence of annual TCD screenings for each of the two years in children ages 2 to 16 years old with SCD.

#2: To determine the compliance rates of annual TCD screening over two consecutive years in children ages 2 to 16 years old with SCD.

#3: To determine patient demographic characteristics (age, sex, and residential location) and healthcare providers (Pediatrician, Hematologists, Neurologists, Nurse Practitioner (NP), Physician’s Assistant (PA), and other specialists) associated with annual TCD screening prevalence, incidence, and compliance rates in children with SCD receiving NC Medicaid. H1: Annual TCD screening prevalence, incidence, and compliance rate will be higher among children ages 6 to 11 years old because typically, TCD screenings are performed only when children exhibit difficulties in school, especially at the elementary level. H2: Annual TCD screening prevalence, incidence, and compliance rate will be less frequent among children of lower SES because of limited family income or poverty level. H3: Annual TCD screening prevalence, incidence, and compliance rate will be higher among Hematologists because they primarily manage patients with SCD.