2
|
Scarlet S, Sweeting RS, Ataga KI, Redding-Lallinger RC, Meyer AA. An Interdisciplinary Perioperative Management Protocol for Patients with Sickle Cell Anemia: A Single-Surgeon Experience. Am Surg 2018. [DOI: 10.1177/000313481808400676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sara Scarlet
- University of North Carolina at Chapel Hill Chapel Hill, North Carolina
| | | | - Kenneth I. Ataga
- University of North Carolina at Chapel Hill Chapel Hill, North Carolina
| | | | - Antony A. Meyer
- University of North Carolina at Chapel Hill Chapel Hill, North Carolina
| |
Collapse
|
3
|
King AA, Rodeghier MJ, Panepinto JA, Strouse JJ, Casella JF, Quinn CT, Dowling MM, Sarnaik SA, Thompson AA, Woods GM, Minniti CP, Redding-Lallinger RC, Kirby-Allen M, Kirkham FJ, McKinstry R, Noetzel MJ, White DA, Kwiatkowski JK, Howard TH, Kalinyak KA, Inusa B, Rhodes MM, Heiny ME, Fuh B, Fixler JM, Gordon MO, DeBaun MR. Silent cerebral infarction, income, and grade retention among students with sickle cell anemia. Am J Hematol 2014; 89:E188-92. [PMID: 25042018 DOI: 10.1002/ajh.23805] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 11/11/2022]
Abstract
Children with sickle cell anemia have a higher-than-expected prevalence of poor educational attainment. We test two key hypotheses about educational attainment among students with sickle cell anemia, as measured by grade retention and use of special education services: (1) lower household per capita income is associated with lower educational attainment; (2) the presence of a silent cerebral infarct is associated with lower educational attainment. We conducted a multicenter, cross-sectional study of cases from 22 U.S. sites included in the Silent Infarct Transfusion Trial. During screening, parents completed a questionnaire that included sociodemographic information and details of their child's academic status. Of 835 students, 670 were evaluable; 536 had data on all covariates and were used for analysis. The students' mean age was 9.4 years (range: 5-15) with 52.2% male; 17.5% of students were retained one grade level and 18.3% received special education services. A multiple variable logistic regression model identified that lower household per capita income (odds ratio [OR] of quartile 1 = 6.36, OR of quartile 2 = 4.7, OR of quartile 3 = 3.87; P = 0.001 for linear trend), age (OR = 1.3; P < 0.001), and male gender (OR, 2.2; P = 0.001) were associated with grade retention; silent cerebral infarct (P = 0.31) and painful episodes (P = 0.60) were not. Among students with sickle cell anemia, household per capita income is associated with grade retention, whereas the presence of a silent cerebral infarct is not. Future educational interventions will need to address both the medical and socioeconomic issues that affect students with sickle cell anemia.
Collapse
Affiliation(s)
- Allison A. King
- Program in Occupational Therapy and Department of Pediatrics, Hematology/Oncology, Washington University School of Medicine; St. Louis Missouri
| | | | - Julie Ann Panepinto
- Division of Hematology/Oncology; Department of Pediatrics; Medical College of Wisconsin; Milwaukee Wisconsin
| | - John J. Strouse
- Division of Hematology/Oncology; Department of Pediatrics; Hematology/Oncology; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - James F. Casella
- Division of Hematology/Oncology; Department of Pediatrics; Hematology/Oncology; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Charles T. Quinn
- Division of Hematology/Oncology; Department of Pediatrics; Cincinnati Children's Hospital Medical Center and University of Cincinnati; Cincinnati Ohio
| | - Michael M. Dowling
- Departments of Pediatrics; Neurology; and Neurotherapeutics; University of Texas Southwestern Medical School; Dallas Texas
| | - Sharada A. Sarnaik
- Division of Hematology/Oncology; Department of Pediatrics; Wayne State University; Detroit Michigan
| | - Alexis A. Thompson
- Division of Hematology/Oncology; Department of Pediatrics; Northwestern University; Chicago Illinois
| | - Gerald M. Woods
- Division of Hematology/Oncology; Department of Pediatrics; University of Missouri-Kansas City; Kansas City Missouri
| | - Caterina P. Minniti
- National Heart; Lung and Blood Institute; National Institutes of Health; Bethesda Maryland
| | - Rupa C. Redding-Lallinger
- Division of Hematology/Oncology; Department of Pediatrics; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | | | - Fenella J. Kirkham
- Neurosciences Unit; Institute of Child Health; University College London; London United Kingdom
| | - Robert McKinstry
- Department of Radiology; Washington University School of Medicine; St. Louis Missouri
| | - Michael J. Noetzel
- Departments of Neurology and Pediatrics; Washington University School of Medicine; St. Louis Missouri
| | - Desiree A. White
- Department of Psychology; Washington University; St. Louis Missouri
| | - Janet K. Kwiatkowski
- Division of Hematology/Oncology; Department of Pediatrics; University of Pennsylvania, Children's Hospital of Philadelphia; Philadelphia Pennsylvania
| | - Thomas H. Howard
- Division of Hematology/Oncology; Department of Pediatrics; University of Alabama at Birmingham; Birmingham Alabama
| | - Karen A. Kalinyak
- Division of Hematology/Oncology; Department of Pediatrics; Cincinnati Children's Hospital Medical Center and University of Cincinnati; Cincinnati Ohio
| | - Baba Inusa
- Department of Paediatrics; Evelina Children's Hospital; St Thomas' Hospital National Health Service Trust; London United Kingdom
| | - Melissa M. Rhodes
- Division of Hematology/Oncology; Department of Pediatrics; The Ohio State University; Columbus Ohio
| | - Mark E. Heiny
- Division of Hematology/Oncology; Department of Pediatrics; Indiana University-Purdue University Indiana; Indianapolis Indiana
| | - Ben Fuh
- Division of Hematology/Oncology; Department of Pediatrics; Brody School of Medicine; Greenville North Carolina
| | - Jason M. Fixler
- Division of Hematology/Oncology; Department of Pediatrics; Sinai Hospital; Baltimore Maryland
| | - Mae O. Gordon
- Department of Ophthalmology and Visual Sciences; Biostatistics; Washington University School of Medicine; St. Louis Missouri
| | - Michael R. DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease; Division of Hematology/Oncology; Department of Pediatrics; Vanderbilt University; Nashville Tennessee
| |
Collapse
|
4
|
DeBaun MR, Gordon M, McKinstry RC, Noetzel MJ, White DA, Sarnaik SA, Meier ER, Howard TH, Majumdar S, Inusa BPD, Telfer PT, Kirby-Allen M, McCavit TL, Kamdem A, Airewele G, Woods GM, Berman B, Panepinto JA, Fuh BR, Kwiatkowski JL, King AA, Fixler JM, Rhodes MM, Thompson AA, Heiny ME, Redding-Lallinger RC, Kirkham FJ, Dixon N, Gonzalez CE, Kalinyak KA, Quinn CT, Strouse JJ, Miller JP, Lehmann H, Kraut MA, Ball WS, Hirtz D, Casella JF. Controlled trial of transfusions for silent cerebral infarcts in sickle cell anemia. N Engl J Med 2014; 371:699-710. [PMID: 25140956 PMCID: PMC4195437 DOI: 10.1056/nejmoa1401731] [Citation(s) in RCA: 350] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Silent cerebral infarcts are the most common neurologic injury in children with sickle cell anemia and are associated with the recurrence of an infarct (stroke or silent cerebral infarct). We tested the hypothesis that the incidence of the recurrence of an infarct would be lower among children who underwent regular blood-transfusion therapy than among those who received standard care. METHODS In this randomized, single-blind clinical trial, we randomly assigned children with sickle cell anemia to receive regular blood transfusions (transfusion group) or standard care (observation group). Participants were between 5 and 15 years of age, with no history of stroke and with one or more silent cerebral infarcts on magnetic resonance imaging and a neurologic examination showing no abnormalities corresponding to these lesions. The primary end point was the recurrence of an infarct, defined as a stroke or a new or enlarged silent cerebral infarct. RESULTS A total of 196 children (mean age, 10 years) were randomly assigned to the observation or transfusion group and were followed for a median of 3 years. In the transfusion group, 6 of 99 children (6%) had an end-point event (1 had a stroke, and 5 had new or enlarged silent cerebral infarcts). In the observation group, 14 of 97 children (14%) had an end-point event (7 had strokes, and 7 had new or enlarged silent cerebral infarcts). The incidence of the primary end point in the transfusion and observation groups was 2.0 and 4.8 events, respectively, per 100 years at risk, corresponding to an incidence rate ratio of 0.41 (95% confidence interval, 0.12 to 0.99; P=0.04). CONCLUSIONS Regular blood-transfusion therapy significantly reduced the incidence of the recurrence of cerebral infarct in children with sickle cell anemia. (Funded by the National Institute of Neurological Disorders and Stroke and others; Silent Cerebral Infarct Multi-Center Clinical Trial ClinicalTrials.gov number, NCT00072761, and Current Controlled Trials number, ISRCTN52713285.).
Collapse
Affiliation(s)
- Michael R DeBaun
- From the Department of Pediatrics, Division of Hematology-Oncology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University School of Medicine, Nashville (M.R.D.); Department of Ophthalmology and Visual Sciences, Division of Biostatistics (M.G.), Departments of Radiology and Pediatrics (R.C.M.), Neurology and Pediatrics (M.J.N.), and Psychology (D.A.W.), the Program in Occupational Therapy and Department of Pediatrics Hematology-Oncology (A.A.K.), and the Division of Biostatistics and Department of Internal Medicine (J.P.M.), Washington University School of Medicine, St. Louis; Department of Pediatrics, Division of Hematology-Oncology, Wayne State University, Detroit (S.A.S.); Center for Cancer and Blood Disorders, Children's National Medical Center, Department of Pediatrics, George Washington University Medical Center (E.R.M.), and Department of Pediatrics, Division of Hematology-Oncology, Georgetown University Hospital (C.E.G.) - all in Washington, DC; Department of Pediatrics, Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham (T.H.H.); Department of Pediatrics, Division of Hematology-Oncology, University of Mississippi Medical Center, Jackson (S.M.); Department of Paediatrics, Evelina Children's Hospital, St. Thomas' Hospital NHS Trust (B.P.D.I.), Department of Pediatric Hematology, Royal London Hospital, Barts Health NHS Trust (P.T.T.), and the Neurosciences Unit, Institute of Child Health, University College London (F.J.K.) - all in London; Hospital for Sick Children, Department of Paediatrics, Haematology-Oncology, University of Toronto, Toronto (M.K.-A.); Division of Hematology-Oncology, Department of Pediatrics, UT Southwestern Medical Center, Dallas (T.L.M.C.); Département Pédiatrie, Hôpital Intercommunal de Creteil, Creteil, France (A.K.); Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston (G.A.); Department of Pediatrics, Hematology-Oncology, Univer
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|