title: Prospective evaluation of the clinical utility of quantitative bleeding severity assessment in patients referred for hemostatic evaluation.
abstract: BACKGROUND
  Quantitative bleeding assessment tools (BATs) have been used to describe the severity of the bleeding phenotype in patients with von Willebrand disease.
  
  
  OBJECTIVE
  To evaluate the clinical usefulness of a BAT for the diagnosis of mild bleeding disorders (MBDs) in previously undiagnosed patients.
  
  
  METHODS
  We prospectively assessed 215 patients who were consecutively referred for evaluation of bleeding symptoms (n=71), abnormal laboratory clotting test results (n=105) or family investigation (n=39) at two second-level centers. The bleeding history was assessed by a young investigator who administered the BAT instrument, and also by a senior physician who independently evaluated the patient and made the final diagnoses. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were computed for a predefined bleeding score (BS) cut-off (BS of >3). Receiver operating characteristic curves were used to establish a diagnostic prediction rule.
  
  
  RESULTS
  Assuming the prevalence of MBD in the general population to be ∼1%, a normal BS (≤3) had a very high NPV (99.2%). The PPVs in patients referred for hemostatic or family evaluation at second-level clinics were estimated to be 71.0% and 77.5% (assuming MDB prevalences of 20% and 50%, respectively, in these settings). Measurement of BS in addition to activated partial thromboplastin time significantly increased the diagnostic efficiency of the BAT instrument (NPV of 99.6%).
  
  
  CONCLUSIONS
  BAT use improves the evaluation of patients with suspected MBD, and we propose its use in a clinical prediction guide based on BAT and activated partial thromboplastin time for the exclusion of patients with suspected MBD in a low-prevalence setting.
authors: Department of Hematology, San Bortolo Hospital, Vicenza, Italy. tosetto@hemato.ven.it
authors: A
authors: A
authors: Tosetto
authors: G
authors: G
authors: Castaman
authors: I
authors: I
authors: Plug
authors: F
authors: F
authors: Rodeghiero
authors: J
authors: J
authors: Eikenboom
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001791:Blood Platelet Disorders; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006470:Hemorrhage / Q000175:diagnosis*; D006487:Hemostasis; D006801:Humans; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult; D014842:von Willebrand Diseases / Q000150:complications