title: Is the Pictorial Blood Loss Assessment Chart (PBAC) score associated with treatment outcome after endometrial ablation for heavy menstrual bleeding? A cohort study.
abstract: OBJECTIVE
  The Pictorial Blood Loss Assessment Chart (PBAC) is a validated tool that is used to diagnose heavy menstrual bleeding (HMB). Knowledge of the effect of its score and its relationship with outcome could have implications for using the PBAC as an outcome measurement in future HMB studies, and as a tool to evaluate the treatment effect in research and clinical practice. Our aim was to relate PBAC scores to other measures of success after endometrial ablation for HMB.
  
  
  METHODS
  Analysis of individual patient data (IPD) of randomised controlled trials studying women with HMB.
  
  
  METHODS
  Women with HMB consulting their gynecologists.
  
  
  METHODS
  Individual patient data (IPD) of randomised controlled trials studying women with HMB.
  
  
  METHODS
  We included studies if they had studied second-generation endometrial ablation techniques and had collected PBAC scores for both baseline and follow-up. The effectiveness of treatment was scored as satisfaction or re-intervention (yes/no) 12 months after treatment. We related these outcomes to the PBAC score at 12 months after treatment, and to PBAC decrease between baseline and 12 months of follow-up.
  
  
  RESULTS
  We studied data for 900 patients included in nine studies. The median PBAC score at 12 months was 7 (0-2500). The overall satisfaction rate was 89% and the overall re-intervention rate was 7.2%. A clear association was found between absolute PBAC score at the 12-month follow-up and satisfaction (odds ratio, OR 0.16; 95% confidence interval, 95% CI 0.11-0.24) and surgical re-intervention (OR 2.3, 95% CI 1.8-2.8). A change in PBAC score was also associated with satisfaction (OR 2.0, 95% CI 1.7-2.3) and surgical re-intervention (OR 0.69, 95% CI 0.63-0.75). Both the absolute PBAC scores and the changes in score show high accuracy for both treatment outcomes.
  
  
  CONCLUSIONS
  PBAC scores at 12 months after treatment are significantly associated with satisfaction and re-intervention rates. We propose to use the PBAC in research as a primary end point in studies on HMB, and in clinical practice as a measure to assess the effectiveness of treatment.
  
  
  CONCLUSIONS
  PBAC scores 12 months after treatment are significantly associated with satisfaction and reintervention rates.
authors.affiliation: Department of Obstetrics & Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Herman
authors.affiliation: Department of Obstetrics & Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Mak
authors.affiliation: Department of Obstetrics & Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: Geomini
authors.affiliation: Department of Methodology and Statistics, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Winkens
authors.affiliation: The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia.
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics & Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands.|Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: M Y
authors.initials: MY
authors.lastname: Bongers
authors.affiliation: Department of Obstetrics & Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands.
mesh_terms: D000328:Adult; D015331:Cohort Studies; D055356:Endometrial Ablation Techniques; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000601:surgery*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: Pictorial Blood Loss Assessment Chart; endometrial ablation; heavy menstrual bleeding