Practical-Manual-Scores-Algorithms-Haemostasis-Thrombosis

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BleedingPediatric bleeding assessment tool for the evaluationof bleeding severity in childrenIndicationQuantitative assessment of the severity of bleeding symptoms in young patientsreferred for the evaluation of a suspected congenital bleeding disorder.The Pediatric Bleeding Assessment is formed by two components: the PediatricBleeding Questionnaire (PBQ) and the Bleeding Score, essentially derived fromthe one used by the European Study on type 1 VWD. The Pediatric BleedingAssessment tool was originally developed to evaluate address pediatric-specificbleeding symptoms, and all its items in the questionnaire are now representedalso in the ISTH Bleeding Assessment Tool. The PBQ is however presentedsince many studies in children used this score.1. Pediatric Bleeding Questionnaire (PBQ): The bleeding questionnaireallows to accurately record the worst-ever presentation for each bleedingsymptom. The bleeding questionnaire is publicly available at:http://onlinelibrary.wiley.com/doi/10.1111/j.1538-7836.2009.03499.x/fullThere is no electronic version of the questionnaire available so far.2. Bleeding Score: The severity of symptoms collected with the PBBQ isscored according to the following table and all obtained values are summedtogether. The final result is the Pediatric Bleeding Score, an index of the overallseverity of the bleeding phenotype in children.Interpretation (see tables on p. 51-52)A Bleeding Score ≥ 2 is considered suggestive for the presence of a bleedingdisorder. The sensitivity, specificity, positive predictive value and negativepredictive value of the PBQ are 83%, 79%, 0.14, and 0.99 respectively for thediagnosis of von Willebrand’s disease in a secondary care setting. The PBQ isconsistently elevated in children with platelet function disorders.References• Biss TT, Blanchette VS, Clark DS, et al. Quantitation of bleeding symptoms in childrenwith von Willebrand disease: use of a standardized pediatric bleeding questionnaire.J Thromb Haemost. 2010;8:950-6.• Biss TT, Blanchette VS, Clark DS, et al. Use of a quantitative pediatric bleedingquestionnaire to assess mucocutaneous bleeding symptoms in children with a plateletfunction disorder. J Thromb Haemost 2010;8:1416-9.• Bowman M, Riddel J, Rand ML, et al. Evaluation of the diagnostic utility for von Willebranddisease of a pediatric bleeding questionnaire. J Thromb Haemost. 2009;7:1418-21.50
Pediatric Bleeding scoreSymptoms ScoreEpistaxis No or trivial(≤ 5 per year)Cutaneous No or trivial(≤ 1 cm)Minour wounds No or trivial(≤ 5 per year)–1 0 1 2 3 4> 5 per year OR> 10 minutesduration> 1 cm ANDno trauma> 5 per yearOR > 5 minutesdurationOral cavity No Reportedat least onceGastrointestinaltractTooth extraction No bleedingin at least2 extractionsSurgery No bleedingin at least2 surgeriesConsultationonlyConsultationonlyConsultationonly orSteristreapsConsultationonlyNo Identified cause ConsultationorspontaneuousNonedone or nobleeding in1 extractionNone doneor nobleedingin 1 surgeryReported,no consultationReported,no consultationConsultationonlyConsultationonlyPacking, cauterizationor antifibrinolyticsSurgical haemostasisor antifibrinolyticsSurgical haemostasisor antifibrinolyticsSurgical haemostasis,antifibrinolytics, bloodtransfusion, replacementetherapy or demopressinResuturing, repackingor antifibrinolyticsSurgical haemostasisor antifibrinolyticsBlood transfusion,replacement therapyor desmopressinBlood transfusion,replacement therapyor desmopressinBlood transfusion,replacement therapyor desmopressinBlood transfusion,replacement therapyor desmopressinBlood transfusion,replacement therapyor desmopressinBleeding51
Page 1 and 2: Practical manualScores and Algorith
Page 3: Scientific boardHenri BounameauxDiv
Page 6 and 7: SummaryBleedingISTH bleeding assess
Page 9 and 10: Clinical probability model for deep
Page 11 and 12: FeatureGeneva scoresPoints(revised
Page 13 and 14: InterpretationClinical decision rul
Page 15 and 16: 6 features with a similar validity.
Page 17 and 18: Prediction of recurrent deep vein T
Page 19 and 20: Outpatient versus inpatient care in
Page 21 and 22: Assessment of post-thrombotic syndr
Page 23 and 24: Diagnostic algorithm in suspected p
Page 25 and 26: Prediction of stroke risk in patien
Page 27 and 28: References• Camm AJ, Lip GY, De C
Page 29 and 30: References• Friberg L, Rosenqvist
Page 31 and 32: InterpretationThis score identifies
Page 33 and 34: Vienna score (Ay Model): DVT or PE
Page 35 and 36: Risk assessment modelsin hospitaliz
Page 37 and 38: References• Chopard P, Spirk D, B
Page 39 and 40: Recommendations for the determinati
Page 41 and 42: Template for scoring system for non
Page 43 and 44: Diagnosis of Thrombotic Thrombocyto
Page 45 and 46: Management of patientswith occlusio
Page 47 and 48: Symptoms(up to the time of diagnosi
Page 49: InterpretationA bleeding score > 3
Page 53 and 54: Bleeding assessment tool for the ev
Page 55 and 56: The SMOG system (cont.)Type of blee
Page 57 and 58: The SMOG system (cont.)Type of blee
Page 59 and 60: Diagnostic and therapeutic algorith
Page 61 and 62: Bridging strategies in patients on
Page 64: Practical manualof scores and algor

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