Key result
African children show lower cerebral flow velocities than established references, peaking at age 5 to 6.
Why the study?
Pediatric TCD interpretation requires age-matched normative data, but large healthy cohorts have not been examined and normative values are completely absent in African children.
What are the normative transcranial doppler cerebral blood flow velocities across childhood in healthy sub-Saharan African children, and how do they compare to established European reference standards?
Observational (n=710)
Yes
What are the normative transcranial doppler cerebral blood flow velocities across childhood in healthy sub-Saharan African children, and how do they compare to established European reference standards?
Establishes the first pediatric normative transcranial doppler reference values for healthy African children, demonstrating significantly lower velocities after age 3 compared to European standards and improving diagnostic accuracy across the continent.
Supports Africa-specific TCD norms; leaves open whether European references require adjustment in sub-Saharan children.
Background and purpose: Transcranial doppler ultrasound (TCD) is a tool that diagnoses and monitors pathophysiological changes to the cerebrovasculature. As cerebral blood flow velocities (CBFVs) increase throughout childhood, interpretation of TCD examinations in pediatrics requires comparison to age matched normative data. Large cohorts of healthy children have not been examined to develop these reference values in any population. There is a complete absence of normative values in African children where, due to lack of alternate neuroimaging techniques, utilization of TCD is rapidly emerging. Materials and methods: A prospective study of 710 healthy African children 3 months-15 years was performed. Demographics, vital signs, and hemoglobin values were recorded. Participants underwent a complete, non-imaging TCD examination. Systolic (Vs), diastolic (Vd), and mean (Vm) flow velocities and pulsatility index (PI) were calculated by the instrument for each measurement. Results: Vs, Vd, and Vm increased through early childhood in all vessels, with the highest CBFVs identified in children 5-5.9 years. There were few significant gender differences in CBFVs in any vessels in any age group. No correlations between blood pressure or hemoglobin and CBFVs were identified. Children in the youngest age groups had CBFVs similar to those previously published, whereas nearly every vessel in children ≥3 years had significantly lower Vs, Vd, and Vm. Conclusions: For the first time, reference TCD values for African children are established. Utilization of these CBFVs in the interpretation of TCD examinations in this population will improve the overall accuracy of TCD as a clinical tool on the continent.
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O’Brien et al. (2023) conducted an observational in Healthy children undergoing transcranial doppler ultrasound (n=710). Transcranial doppler ultrasound (TCD) examination across pediatric age groups vs. Previously published European normative reference values (Bode et al., 1988) was evaluated on Cerebral blood flow velocities (systolic, diastolic, and mean flow velocities) and pulsatility index across major intracranial vessels by age (p=<0.001). Transcranial doppler in 710 healthy African children revealed peak velocities at 5-5.9 years and significantly lower flow velocities in children >=3 years than prior reference values (p<0.001).
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