Bleeding assessment tools to predict von Willebrand disease: Utility of individual bleeding symptoms

Abstract Background Bleeding assessment is part of the diagnostic workup of von Willebrand disease (VWD). Bleeding assessment tools (BATs) have standardized obtaining this information but have been criticized because they are time consuming. Objective To use our legacy data to determine which questi...

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Autores principales:	Jordan Spradbrow, Sasha Letourneau, Julie Grabell, Yupu Liang, James Riddel, Wilma Hopman, Victor S. Blanchette, Margaret L. Rand, Barry S. Coller, Andrew D. Paterson, Paula D. James
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2020
Materias:	hemorrhage hemostasis surveys and questionnaires symptom assessment von Willebrand disease Diseases of the blood and blood-forming organs RC633-647.5
Acceso en línea:	https://doaj.org/article/2908119b4e5244759debe0e1f14093fe
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spelling	oai:doaj.org-article:2908119b4e5244759debe0e1f14093fe2021-11-15T06:10:44ZBleeding assessment tools to predict von Willebrand disease: Utility of individual bleeding symptoms2475-037910.1002/rth2.12256https://doaj.org/article/2908119b4e5244759debe0e1f14093fe2020-01-01T00:00:00Zhttps://doi.org/10.1002/rth2.12256https://doaj.org/toc/2475-0379Abstract Background Bleeding assessment is part of the diagnostic workup of von Willebrand disease (VWD). Bleeding assessment tools (BATs) have standardized obtaining this information but have been criticized because they are time consuming. Objective To use our legacy data to determine which questions from BATs are the strongest predictors of a VWD diagnosis. Patients/Methods Bleeding score data from 3 different BATs were used. Patients aged <12 years were excluded. Questions on BATs relate to different bleeding symptoms, and each symptom is scored by severity. Scores for each symptom were sorted based on whether they indicated clinically significant bleeding, and nonsignificant scores were set as the reference category. Multivariable logistic regression was used to determine the symptoms that were the strongest predictors of a laboratory‐confirmed VWD diagnosis. Results A total of 927 participants were included; 144 (16%) were patients with VWD, and 783 (84%) were healthy controls. The top 3 symptoms for which a clinically significant positive response increased the likelihood of VWD were hemarthrosis (odds ratio [OR], 19.2; 95% confidence interval [CI], 3.7‐100.4), postsurgical bleeding (OR, 15.2; 95% CI, 5.9‐38.9), and menorrhagia (OR, 10.3; 95% CI, 4.9‐21.9). With each increase in number of bleeding symptom categories with clinically significant scores, subjects had a stepwise increase in odds of a VWD diagnosis. Conclusions Our results suggest that most of the bleeding symptoms on BATs are significant predictors of VWD, and there is value in assessing multiple bleeding symptoms when eliciting a bleeding history. Certain bleeding symptoms are more useful predictors than others. Future BAT revisions may consider adding a relative weighting to each symptom.Jordan SpradbrowSasha LetourneauJulie GrabellYupu LiangJames RiddelWilma HopmanVictor S. BlanchetteMargaret L. RandBarry S. CollerAndrew D. PatersonPaula D. JamesWileyarticlehemorrhagehemostasissurveys and questionnairessymptom assessmentvon Willebrand diseaseDiseases of the blood and blood-forming organsRC633-647.5ENResearch and Practice in Thrombosis and Haemostasis, Vol 4, Iss 1, Pp 92-99 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	hemorrhage hemostasis surveys and questionnaires symptom assessment von Willebrand disease Diseases of the blood and blood-forming organs RC633-647.5
spellingShingle	hemorrhage hemostasis surveys and questionnaires symptom assessment von Willebrand disease Diseases of the blood and blood-forming organs RC633-647.5 Jordan Spradbrow Sasha Letourneau Julie Grabell Yupu Liang James Riddel Wilma Hopman Victor S. Blanchette Margaret L. Rand Barry S. Coller Andrew D. Paterson Paula D. James Bleeding assessment tools to predict von Willebrand disease: Utility of individual bleeding symptoms
description	Abstract Background Bleeding assessment is part of the diagnostic workup of von Willebrand disease (VWD). Bleeding assessment tools (BATs) have standardized obtaining this information but have been criticized because they are time consuming. Objective To use our legacy data to determine which questions from BATs are the strongest predictors of a VWD diagnosis. Patients/Methods Bleeding score data from 3 different BATs were used. Patients aged <12 years were excluded. Questions on BATs relate to different bleeding symptoms, and each symptom is scored by severity. Scores for each symptom were sorted based on whether they indicated clinically significant bleeding, and nonsignificant scores were set as the reference category. Multivariable logistic regression was used to determine the symptoms that were the strongest predictors of a laboratory‐confirmed VWD diagnosis. Results A total of 927 participants were included; 144 (16%) were patients with VWD, and 783 (84%) were healthy controls. The top 3 symptoms for which a clinically significant positive response increased the likelihood of VWD were hemarthrosis (odds ratio [OR], 19.2; 95% confidence interval [CI], 3.7‐100.4), postsurgical bleeding (OR, 15.2; 95% CI, 5.9‐38.9), and menorrhagia (OR, 10.3; 95% CI, 4.9‐21.9). With each increase in number of bleeding symptom categories with clinically significant scores, subjects had a stepwise increase in odds of a VWD diagnosis. Conclusions Our results suggest that most of the bleeding symptoms on BATs are significant predictors of VWD, and there is value in assessing multiple bleeding symptoms when eliciting a bleeding history. Certain bleeding symptoms are more useful predictors than others. Future BAT revisions may consider adding a relative weighting to each symptom.
format	article
author	Jordan Spradbrow Sasha Letourneau Julie Grabell Yupu Liang James Riddel Wilma Hopman Victor S. Blanchette Margaret L. Rand Barry S. Coller Andrew D. Paterson Paula D. James
author_facet	Jordan Spradbrow Sasha Letourneau Julie Grabell Yupu Liang James Riddel Wilma Hopman Victor S. Blanchette Margaret L. Rand Barry S. Coller Andrew D. Paterson Paula D. James
author_sort	Jordan Spradbrow
title	Bleeding assessment tools to predict von Willebrand disease: Utility of individual bleeding symptoms
title_short	Bleeding assessment tools to predict von Willebrand disease: Utility of individual bleeding symptoms
title_full	Bleeding assessment tools to predict von Willebrand disease: Utility of individual bleeding symptoms
title_fullStr	Bleeding assessment tools to predict von Willebrand disease: Utility of individual bleeding symptoms
title_full_unstemmed	Bleeding assessment tools to predict von Willebrand disease: Utility of individual bleeding symptoms
title_sort	bleeding assessment tools to predict von willebrand disease: utility of individual bleeding symptoms
publisher	Wiley
publishDate	2020
url	https://doaj.org/article/2908119b4e5244759debe0e1f14093fe
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Bleeding assessment tools to predict von Willebrand disease: Utility of individual bleeding symptoms

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