title: Grading of hemorrhage in children with idiopathic thrombocytopenic purpura.
abstract: OBJECTIVE
  To develop an instrument to allow semiquantitative assessment of hemorrhage in children with idiopathic thrombocytopenic purpura (ITP).
  
  
  METHODS
  Bleeding severity was graded on a scale of 0 to 4 in 4 different sites (overall, oral, epistaxis, and skin) on the basis of history during the previous 24 hours and physical examination.
  
  
  RESULTS
  Children with ITP (n = 54) were assessed on 109 different occasions by multiple observers, including 81 measurements by one of the authors. Grade of bleeding correlated inversely with platelet count. Grade 3 or 4 hemorrhage was infrequently encountered except involving the skin, where assessment was difficult. Grade 4 mucosal or internal hemorrhage was noted in 7 patients; none had life-threatening or fatal bleeding. Interrater agreement in grading of overall and mouth bleeding and epistaxis was acceptable.
  
  
  CONCLUSIONS
  We conclude that scoring of hemorrhage is possible in children with ITP and that the grade of hemorrhage may represent a clinically meaningful end point in future studies.
authors.affiliation: Division of Hematology-Oncology, Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Texas, USA.
authors.forename: George R
authors.initials: GR
authors.lastname: Buchanan
authors.forename: Leah
authors.initials: L
authors.lastname: Adix
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D023381:Endpoint Determination; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D008297:Male; D010976:Platelet Count; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000473:pathology