title: Development of CAPTSureTM- a new index for the assessment of pediatric postthrombotic syndrome.
abstract: Essentials We developed a discriminative and evaluative index for pediatric postthrombotic syndrome (PTS). A Delphi-survey was used for item reduction and multi-criteria decision analysis for item weighting. The new index assesses limb PTS based on the relative severity of each sign and symptom. Higher scores related to higher odds of parental dissatisfaction with their child's condition.
  
  
  
  Background Postthrombotic syndrome (PTS) is a complication of deep vein thrombosis defined by the presence of characteristic signs and symptoms. We developed a discriminative and evaluative index for the assessment of upper extremity (UE) and lower extremity (LE) pediatric PTS. Methods The items to be included in the index were voted for by 26 pediatric thrombosis experts invited to participate in a Delphi survey. Subsequent item weighting was based on item importance elicited by the use of multicriteria decision analysis (MCDA); 122 healthcare providers and patients/parents were invited to participate in item weighting. The implications of the overall scores were explored by comparison with PTS diagnosis (independently assessed by two clinical experts) and parental satisfaction/dissatisfaction with their child's current condition. Results Items voted for inclusion by at least 70% of the Delphi survey respondents (81% response rate) were pain, paresthesia, swelling, heaviness, endurance, collateral circulation and arm circumference difference for the UE, and pain, paresthesia, swelling, heaviness, tightness, tired limb, redness/purple or blotchy skin, endurance, ulcers and thigh/calf circumference difference for the LE. Items were then weighted by the use of MCDA (82% response rate). The index had excellent discrimination for patients with/without PTS. For every 10-point increase in index scores (with higher scores being indicative of worse PTS), the odds of parental dissatisfaction increased by 75% and 92% in the UE and LE, respectively. Conclusion We report the development of the CAPTSure™ (index for the Clinical Assessment of Postthrombotic Syndrome in children), which reflects collective judgement of the severity of pediatric PTS. We also provide information on the meaning of the scores.
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: M L
authors.initials: ML
authors.lastname: Avila
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: L R
authors.initials: LR
authors.lastname: Brandão
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Williams
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: M I
authors.initials: MI
authors.lastname: Montoya
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.|Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Stinson
authors.affiliation: Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Kiss
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: B M
authors.initials: BM
authors.lastname: Feldman
mesh_terms: D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D003697:Delphi Technique; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D010372:Pediatrics / Q000379:methods*; D054070:Postthrombotic Syndrome / Q000175:diagnosis*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D063189:Symptom Assessment; D016896:Treatment Outcome; D034941:Upper Extremity; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis*
keywords: child; deep vein thrombosis; lower extremity; signs and symptoms; upper extremity