This study looks at whether adding simple family history questions to a standard bleeding questionnaire can better identify children who truly have mild bleeding disorders. Because young children often haven't had major bleeding challenges yet, their own symptoms may not tell the full story, so family history could provide important extra information. By reviewing several years of clinic data, the researchers aim to see if this combined approach helps doctors decide more accurately who needs further testing, especially in children under 8 years old.
This study focuses on improving how doctors evaluate children who may have a mild bleeding disorder, such as von Willebrand disease or platelet function disorders. Doctors already use a standardized bleeding questionnaire to record a child's bleeding symptoms, but this can be difficult in younger children who often haven't had major bleeding challenges like surgery or dental work. To address this, the researchers added a small number of family history questions to the existing tool to see if knowing about bleeding problems in relatives helps predict whether a child truly has a bleeding disorder. The study reviews several years of existing medical records from children and young adults seen in a pediatric hematology clinic. By comparing the standard questionnaire with the expanded version that includes family history, the researchers want to see which approach more accurately identifies patients who go on to receive a confirmed diagnosis. The goal is to help clinicians decide more confidently who needs further testing and who does not, reducing unnecessary and costly lab work while improving diagnosis, especially for children under 8 years old, where bleeding symptoms alone may be misleading.
Study Type
OBSERVATIONAL
Enrollment
1,000
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States
BAT+ Classification
Dichotomous BAT classification (BAT+ vs BAT-) based on predefined age- and sex-specific BAT cutoffs.
Time frame: From January 2019, through December 1, 2024
Bleeding Assessment Tool (BAT) Score
Total BAT score calculated according to standardized criteria to quantify bleeding symptoms.
Time frame: From January 2019, through December 1, 2024
Probability of Diagnosed Bleeding Disorder Based on BAT Score
Predicted pretest probability of a confirmed bleeding disorder diagnosis (vWD, platelet function disorder, coagulation factor deficiency, or fibrinolytic disorder) estimated using logistic regression models with BAT score as a continuous predictor.
Time frame: From January 2019, through December 1, 2024
Probability of Diagnosed Bleeding Disorder Based on BAT+ Status
Predicted pretest probability of a confirmed bleeding disorder diagnosis estimated using logistic regression models with BAT+ classification as the primary predictor.
Time frame: From January 2019, through December 1, 2024
Confirmed Bleeding Disorder Diagnosis by Category
Final clinical diagnosis categorized as von Willebrand disease, platelet function disorder, coagulation factor deficiency, fibrinolytic disorder, or no bleeding disorder, using standardized diagnostic criteria.
Time frame: From January 2019, through December 1, 2024
Diagnostic Accuracy of BAT
Diagnostic accuracy of the Bleeding Assessment Tool (BAT) for identifying a confirmed bleeding disorder, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), using an initial cutoff score of ≥3. Optimized cutoff scores will be reassessed using ROC analysis and Youden's Index.
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Time frame: From January 2019, through December 1, 2024
Diagnostic Accuracy of BAT+
Diagnostic accuracy of the BAT+ classification for identifying a confirmed bleeding disorder, including sensitivity, specificity, PPV, and NPV, using an initial cutoff score of ≥6. Optimized cutoffs will be reassessed using ROC analysis and Youden's Index.
Time frame: From January 2019, through December 1, 2024
Likelihood Ratios for BAT
Positive likelihood ratio for BAT at the initial cutoff score of ≥3 and at optimized cutoffs derived from ROC analysis.
Time frame: From January 2019, through December 1, 2024
Likelihood Ratios for BAT+
Positive likelihood ratio for BAT+ at the initial cutoff score of ≥6 and at optimized cutoffs derived from ROC analysis.
Time frame: From January 2019, through December 1, 2024
Area Under the ROC Curve (AUC) for BAT
Area under the receiver operating characteristic (ROC) curve for BAT scores derived from logistic regression models discriminating confirmed bleeding disorder diagnosis (yes/no).
Time frame: From January 2019, through December 1, 2024
Area Under the ROC Curve (AUC) for BAT+
Area under the ROC curve for BAT+ classification derived from logistic regression models discriminating confirmed bleeding disorder diagnosis (yes/no).
Time frame: From January 2019, through December 1, 2024
Optimized BAT Cutoff Score
Optimized BAT cutoff score identified using Youden's Index based on ROC curve analysis.
Time frame: From January 2019, through December 1, 2024
Optimized BAT+ Cutoff Score
Optimized BAT+ cutoff identified using Youden's Index based on ROC curve analysis.
Time frame: From January 2019, through December 1, 2024