title: Preoperative hemostatic assessment: a new and simple bleeding questionnaire.
abstract: OBJECTIVE
  Current recommendations for the assessment of the risk of perioperative bleeding limit coagulation testing to patients with a personal and/or family history of bleeding. As no simple preoperative screening questionnaire is currently available, we assessed the performance of a novel screening questionnaire for its ability to detect bleeding disorders.
  
  
  METHODS
  A dichotomized, seven-point questionnaire named HEMSTOP (Hematoma, hEmorrhage, Menorrhagia, Surgery, Tooth extraction, Obstetrics, Parents) was applied to three groups of subjects: patients referred to hemostasis specialists for bleeding symptoms for whom any kind of perioperative hemostatic precautions were subsequently recommended (n = 38); patients referred to hemostasis specialists for whom precautions were not required (n = 75); healthy volunteers (n = 70). We calculated the sensitivity and specificity of HEMSTOP scores and compared them with the discriminative performances of standard blood coagulation assays (prothrombin time, activated partial thromboplastin time).
  
  
  RESULTS
  Patients requiring perioperative hemostatic precautions had greater median [interquartile range] HEMSTOP scores (2 [2-3]) than patients not requiring precautions (1 [1-2]) and healthy controls (0 [0-0]); P < 0.001. A HEMSTOP score ≥ 2 had a specificity of 98.6% [95% confidence interval (CI), 92.3 to 100] and a sensitivity of 89.5% (95% CI, 75.2 to 97.1). The 26.3% (95% CI, 13.4 to 43.1) sensitivity of the standard coagulation times was much lower.
  
  
  CONCLUSIONS
  The HEMSTOP score discriminates patients at an elevated risk for bleeding with recommended perioperative precautions from those without such recommendations as well as from healthy participants. Further evaluation of the HEMSTOP score is required for a better evaluation of its definitive usefulness to predict the risk of perioperative bleeding.
authors.affiliation: Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, 4 rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland. fanny.bonhomme@hcuge.ch.
authors.forename: Fanny
authors.initials: F
authors.lastname: Bonhomme
authors.affiliation: Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Françoise
authors.initials: F
authors.lastname: Boehlen
authors.affiliation: Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, 4 rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Clergue
authors.affiliation: Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: de Moerloose
mesh_terms: D000328:Adult; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005260:Female; D006487:Hemostasis; D020141:Hemostatic Disorders / Q000175:diagnosis*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D019990:Perioperative Care; D015203:Reproducibility of Results; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014914:Whole Blood Coagulation Time