title: Von Willebrand disease in the emergency department.
abstract: BACKGROUND
  The emergency department (ED) is often the first medical contact point for von Willebrand disease (VWD) patients experiencing acute conditions, notably bleeding. However, knowledge of VWD disease types and management options by ED providers is uncertain.
  
  
  OBJECTIVE
  To determine the scope of VWD bleeding and treatment in the ED.
  
  
  METHODS
  We evaluated medical record data in an IRB-approved study from 922 notes accounting for 385 ER visits by 183 VWD patients from a single large institution's emergency department.
  
  
  RESULTS
  Over half the ED visits were for an active or suspected bleed, the majority of which were associated with trauma, surgery, epistaxis, gastrointestinal bleeding or gynaecologic bleeding. By treatment, only 25% of all bleeds, including 77.8% of those with menorrhagia and 50.0% of those with epistaxis, received DDAVP or von Willebrand factor concentrate (VWF). The likelihood of receiving treatment was related to referral source, with the highest rates of treatment in patients referred by a haematologist.
  
  
  CONCLUSIONS
  These data suggest more patient and physician education are needed in managing patients with VWD, preferably at the time of diagnosis, including confirmation of the diagnosis, response to DDAVP testing, indication for DDAVP testing and formulation of a plan for suspected or actual bleeding.
authors.affiliation: Division Hematology/Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Livesey
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Yealy
authors.affiliation: Department of Healthy Policy and Management, Graduate School of Public Health Pittsburgh, Pittsburgh, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Biostatistics, Carolinas Healthcare System, Charlotte, NC, USA.
authors.forename: C G
authors.initials: CG
authors.lastname: Moore
authors.affiliation: Division Hematology/Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.|Hemophilia Center of Western PA, Pittsburgh, PA, USA.
authors.forename: M V
authors.initials: MV
authors.lastname: Ragni
keywords: bleeding; emergency department; treatment; von Willebrand disease