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Prospective evaluation of the clinical utility of quantitative bleeding severity assessment in patients referred for hemostatic evaluation
Author(s) -
TOSETTO A.,
CASTAMAN G.,
PLUG I.,
RODEGHIERO F.,
EIKENBOOM J.
Publication year - 2011
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2011.04265.x
Subject(s) - partial thromboplastin time , medicine , von willebrand disease , predictive value , population , predictive value of tests , coagulation testing , receiver operating characteristic , likelihood ratios in diagnostic testing , prothrombin time , medical diagnosis , positive predicative value , prospective cohort study , surgery , coagulation , von willebrand factor , pathology , platelet , environmental health
Summary. Background: Quantitative bleeding assessment tools (BATs) have been used to describe the severity of the bleeding phenotype in patients with von Willebrand disease. Objectives: 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.