Challenges and Barriers to Effective Transcranial Doppler Screening for Stroke Prevention in Pediatric Sickle Cell Disease: A Cross-Sectional Survey of Physicians in Saudi Arabia
Year: 2026
Type: article
Study design: Observational Study
Abstract: : CONTEXT: Children with sickle cell disease (SCD) are at high risk of cerebrovascular complications. Routine transcranial Doppler (TCD) screening is an established primary stroke prevention strategy recommended annually from the age of 2 years. Despite strong evidence supporting its effectiveness, implementation remains inconsistent, including in Saudi Arabia. AIMS: To assess physicians’ access to TCD services, familiarity with screening guidelines, and perceived barriers to effective TCD screening for pediatric SCD in Saudi Arabia. SETTINGS AND DESIGN: Cross-sectional survey conducted among physicians involved in the care of pediatric patients with sickle cell disease across Saudi Arabia. SUBJECTS AND METHODS: The questionnaire was adapted from the Dissemination and Implementation of Stroke Prevention Looking at the Care Environment (DISPLACE) Consortium survey tool. The survey targeted physicians involved in pediatric SCD care across Saudi Arabia. Responses were analyzed descriptively to assess current TCD screening practices, knowledge, and perceived barriers. RESULTS: A total of 55 physicians participated; most were pediatric hematologists (65.5%). Access to TCD services was reported by 83.6% within their institution. Familiarity with TCD guidelines was high, with 63.6% reporting being very familiar. Pediatric hematologists demonstrated significantly higher knowledge scores than other physicians (3.75 ± 0.50 vs. 3.21 ± 0.79; P = 0.012). TCD examinations were most frequently performed by radiologists (92.7%). For interpretation, 41.8% relied on both velocity values and the radiologist’s report, while 27.3% relied on velocity values alone and 25.5% relied on the radiologist’s interpretation alone. Sedation was not routinely used to facilitate TCD in uncooperative children (65.5% no use, 18.2% occasional use, and 5.5% routine use). The most commonly reported institutional barriers were the shortages of trained sonographers (31%) and limited availability of pediatric radiologists (20%). Patient-related barriers included missed appointments/poor follow-up (56%) and limited family awareness (40%) Although the majority were aware that TCD screening should begin at 2 years of age, variation existed in screening frequency and follow-up practices. Many centers also reported the absence of a standardized local protocol for TCD screening and follow-up. CONCLUSIONS: Physicians in Saudi Arabia reported generally adequate access to TCD services and high awareness of screening guidelines; however, barriers related to human resources, interpretation variability, and patient follow-up persist. Standardized protocols, targeted training, and improved patient engagement may strengthen TCD screening implementation and stroke prevention in children with SCD. No external funding was received.
Source: Journal of Applied Hematology
Institutions: Armed Forces Hospital, Prince Sattam Bin Abdulaziz University
Language: English
Subfield: Genetics
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7213245376