Table 3. Summary of results and... | American Society of Hematology

Table 3.

Summary of results and recommendations

Current guidelines	DISPLACE findings	Recommendations/considerations for future study
1. Measurement of the TAMMV in the MCA and dICA to evaluate stroke risk²	About 52% either did not measure or did not clearly document the measuring of TAMMV. About 30% did not measure both the MCA and dICA. About 68% did not clearly identify which vessels were used to interpret the study.	Standardized data dictionary and reporting template as seen in Figure 1 to reinforce the appropriate velocities to measure and interpret Documentation of additional vessels assessed to facilitate future studies regarding their role in stroke risk screening Repeat the examination for any abnormal velocity of 200-220 cm/sec as recommended by the ASH guidelines⁵ Consider laboratory evaluation and clinical examination at the time of abnormal result
2. Definition of abnormal for TCD AND indication for CRCT: TAMMV ≥200 cm/sec × 2 times or >220 cm/sec once²^,⁵	Sites were uniformly defined abnormal as >200 cm/sec for TCD About 58% did not clearly use the TAMMV to interpret the study. Indications for CRCT are not directly addressed in this study.
3. Definition of abnormal for TCDi AND indication for CRCT: TAMMV ≥185 cm/sec × 2 times or >205 cm/sec once⁵	Significant heterogeneity in the definition of conditional and abnormal for TCDi About 43% of sites utilizing TCDi used angle correction.	Do not use angle correction as this most closely matches the original STOP trial Start with following the ASH recommendations in the United States until new data are available. Use internal quality assurance processes to adjust velocity cut offs as needed for best care
4. Training and calibration: No current guidelines in the United States	Training of ultrasonographers and physicians interpreting studies is variable.	Create joint hematology and radiology interest group Develop a new required training program for all those performing and reading TCDs for stroke risk screening in sickle cell disease Each institution should be consistent in the device used for TCD measurements. Recommend the routine maintenance or recalibration of imaging devices to ensure continued precision Internal quality assurance processes that will identify variations in technique and results

Current guidelines	DISPLACE findings	Recommendations/considerations for future study
1. Measurement of the TAMMV in the MCA and dICA to evaluate stroke risk²	About 52% either did not measure or did not clearly document the measuring of TAMMV. About 30% did not measure both the MCA and dICA. About 68% did not clearly identify which vessels were used to interpret the study.	Standardized data dictionary and reporting template as seen in Figure 1 to reinforce the appropriate velocities to measure and interpret Documentation of additional vessels assessed to facilitate future studies regarding their role in stroke risk screening Repeat the examination for any abnormal velocity of 200-220 cm/sec as recommended by the ASH guidelines⁵ Consider laboratory evaluation and clinical examination at the time of abnormal result
2. Definition of abnormal for TCD AND indication for CRCT: TAMMV ≥200 cm/sec × 2 times or >220 cm/sec once²^,⁵	Sites were uniformly defined abnormal as >200 cm/sec for TCD About 58% did not clearly use the TAMMV to interpret the study. Indications for CRCT are not directly addressed in this study.
3. Definition of abnormal for TCDi AND indication for CRCT: TAMMV ≥185 cm/sec × 2 times or >205 cm/sec once⁵	Significant heterogeneity in the definition of conditional and abnormal for TCDi About 43% of sites utilizing TCDi used angle correction.	Do not use angle correction as this most closely matches the original STOP trial Start with following the ASH recommendations in the United States until new data are available. Use internal quality assurance processes to adjust velocity cut offs as needed for best care
4. Training and calibration: No current guidelines in the United States	Training of ultrasonographers and physicians interpreting studies is variable.	Create joint hematology and radiology interest group Develop a new required training program for all those performing and reading TCDs for stroke risk screening in sickle cell disease Each institution should be consistent in the device used for TCD measurements. Recommend the routine maintenance or recalibration of imaging devices to ensure continued precision Internal quality assurance processes that will identify variations in technique and results