Bleeding Score Improves Mild Bleeding Disorder Diagnosis
Bleeding assessment tools have high negative predictive values and diagnostic efficiency
FRIDAY, April 29 (HealthDay News) -- Use of bleeding assessment tools (BATs) improves the evaluation of patients with suspected mild bleeding disorders (MBD), according to a study published online March 21 in the Journal of Thrombosis and Haemostasis.
Alberto Tosetto, M.D., from the San Bortolo Hospital in Vicenza, Italy, and colleagues evaluated the clinical usefulness of BATs for the diagnosis of MBD in 215 previously undiagnosed patients referred for evaluation of bleeding symptoms (71 patients), abnormal laboratory clotting tests (105 patients), or family investigation (39 patients). They computed the predictive negative and positive values (NPV, PPV), sensitivity, and specificity of BATs for a predefined bleeding score (BS) cutoff of more than three.
The investigators found that a normal BS of three or less had a very high NPV of 99.2 percent, assuming that MBD had a prevalence of 1 percent in the general population. In patients referred for hemostatic or familial evaluation, PPV was estimated to be 71.0 and 77.5 percent, respectively, assuming an MBD prevalence of 20 and 50 percent, respectively. The diagnostic efficiency of the BAT instrument was increased significantly (NPV, 99.6 percent) by measuring activated partial thromboplastin in addition to BS.
"We found that the addition of a standardized bleeding assessment tool is valuable over assessment of MBD based on laboratory screening alone," the authors write. "We encourage the use of a standardized BAT in the prospective evaluation of patients referred for hemostatic evaluation."