Predicting Operative Bleeding in Elective Pediatric Surgeries Using the Pediatric Bleeding Questionnaire (PBQ)

Sim, Andrew Y.; Bowman, Mackenzie; Hopman, Wilma M.; Engen, Dale; Silva, Mariana; James, Paula

doi:10.1097/mph.0b013e31829b9315

Cited by 7 publications

(11 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, perhaps a more remarkable and unexpected result of this study is the demonstration that future bleeding events and therapy requirements were poorly predicted or not predictable at all in the great majority of unequivocal abnormal bleeders with VWD (BS of 5-10), irrespective of their VWF:RCo values. This finding in less symptomatic cases is in line with previous reports from pediatric outpatient and tertiary-care clinics [16,17], casting serious doubt on the predictive value of the BS in patients with mild bleeding disorders.…”

supporting

confidence: 89%

See 1 more Smart Citation

Diagnosing type 1 von Willebrand disease: good for patient's health or for doctor's prestige?: comment

Mezzano

Zúñiga

Pereira

et al. 2014

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

We read with interest the commentary by Rodeghiero et al. [1] regarding the diagnosis of type 1 von Willebrand disease (VWD), which affects 80-90% of all patients with VWD. More than 40 years ago, Zimmerman and Edgington [2] reported that the molecules possessing factor VIII coagulant activity (FVIII:C) and von Willebrand factor (VWF) properties could be physically segregated and identified as different molecular entities. This pivotal discovery made it possible to diagnose type 1 VWD and the different VWD subtypes. The advent of mAbs, molecular biology approaches, cell adhesion under flow conditions, and transgenic animal models, among other developments, made it possible to understand the pathophysiology of VWD, the molecular diagnosis of the VWD subtypes, and the treatment alternatives for this disorder. Pathophysiologically, type 1 VWD is defined by partial quantitative deficiency of plasma VWF antigen level with a parallel decrease in VWF activity (usually measured as VWF ristocetin cofactor activity [VWF:RCo] and/or VWF collagen binding). Although this seems simple and straightforward, there is still no global consensus on the plasma VWF cut-off values for the laboratory diagnosis of this frequent subtype. A recent survey [3] showed that only 27% of North American specialized hemostasis laboratories adhered to National Heart, Lung and Blood Institute (NHLBI) expert panel guidelines [4].The objective of our study [5], referred to in the commentary by Rodeghiero et al., was to compare the various laboratory criteria recommended by authoritative groups for the diagnosis of type 1 VWD, which were based largely on expert opinion and little experimental evidence.We analyzed 4298 laboratory evaluations of patients referred to us during a 5-year period. Succinctly, the same data analyzed according to four proposed criteria led to an almost three-fold difference in the diagnostic rate of type 1 VWD, ranging from between 2.8% (NHLBI recommendation; similar to that recently adopted by the British Committee for Standards in Haematology [6]) to 8.3% (Zimmerman Program for the Molecular and Clinical Biology of VWD criterion) [7]. Therefore, adopting either choice leads to disparate outcomes. We think that these laboratory ranges are unacceptably broad and that their accurate demarcation should be a priority.Rodeghiero correctly criticizes the lack of bleeding score (BS) and family history in our patients; we share this concern, because, without these components, there is no disease to investigate. Diagnosing type 1 VWD on the basis of laboratory values only, without considering bleeding symptoms and inheritance, is as unreasonable as predicting VWD on the basis of the BS only. The authors are also correct in suspecting that an uncertain number of the patients included in our report could have had no abnormal bleeding had they had completed a comprehensive bleeding questionnaire. Nevertheless, this lack of information does not invalidate the central message: the wide variation in diagnotic yield obtained with the isolate...

show abstract

supporting

confidence: 89%

“…VWD and PFD) against referred patients with abnormal bleeding but normal laboratory test results (bleeding of undefined cause) had minimal discriminatory power. These conclusions were also reached with the use of odds ratios, logistic regression analysis, positive and negative LRs, and receiver operating characteristic curves [1,17].…”

mentioning

confidence: 87%

Diagnosing type 1 von Willebrand disease: good for patient's health or for doctor's prestige?: comment

Mezzano

Zúñiga

Pereira

et al. 2014

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

“…Even if we cannot exclude that the administration of antifibrinolytic therapy has reduced the bleeding incidence in our population, we assumed that if a symptomatic bleeding disorder was present, this prophylaxis would not be able to effectively reduce the risk of bleeding. In our case series, PBQ showed a very low PPV and sensitivity against a good specificity and NPV (93.3% and 98.3% respectively), similarly to outcomes reported by Sim et al [6]. Although these specificity and the NPV are desirable for a screening tool, our observation is not conclusive due to the limited sample size of our population and larger studies are required to confirm these data.…”

supporting

confidence: 72%

“…The diagnostic accuracy of PBQ in identifying bleeding tendencies has been tested recently in children undergoing AT surgery [6]. The PBQ has revealed to have a low positive predicting value (PPV) and a low sensitivity against a high specificity and negative predicting value (NPV) (97% and 98% respectively) in identifying patients at high risk of bleeding after elective surgery but was not indicated as an effective screening tool due to the limited population size.…”

mentioning

confidence: 99%

Predicting early and delayed bleedings in children who undergo adeno‐tonsillectomy surgery. Is it really possible?

et al. 2014

View full text Add to dashboard Cite

“…This history is limited in young children, who usually have often not yet encountered such bleeding challenges. 26 This may explain why relatively few patients scored high on the PBQ, and it is reasonable to assume that the chance for scoring higher on this questionnaire will increase with age. Another limitation of this study is the homogeneity of the research group, which was composed of a Middle Eastern population.…”

Section: Discussionmentioning

confidence: 99%

Utility of the Pediatric Bleeding Questionnaire in Predicting Posttonsillectomy Bleeding

Levy

Kuperman

Sela

et al. 2021

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

Objective Posttonsillectomy bleeding is a dreadful complication that may be life-threatening. Preoperative coagulation tests have not been shown to be effective in predicting this complication. The Pediatric Bleeding Questionnaire (PBQ) is a validated and sensitive tool in diagnosing children with abnormal hemostatic functions, and the objective of our study was to assess its utility as a preoperative screening tool for predicting posttonsillectomy bleeding. Study Design Prospective single-blinded cohort study. Setting Tertiary care hospital system. Methods All children scheduled for tonsil surgery between 2017 and 2019 in the Galilee Medical Center were included. The PBQ was completed by the caregivers prior to surgery, and all children underwent coagulation tests. Each PBQ item is scored on a scale of −1 to 4, and the total score per candidate is based on summation of all items. Results An overall 272 patients were included in the study with a mean age of 5.2 years; 57.7% were boys. The main finding was that in a multivariable model adjusted to age, a PBQ score of 2 is correlated with increased postoperative bleeding risk (odds ratio, 10.018 [95% CI, 1.20-82.74]; P = .046). The results of the PBQ demonstrated better predictive ability when compared with abnormal coagulation test results (odds ratio, 1.76 [95% CI, 0.63-4.80]; P = .279). Sex was not found to be significant (odds ratio, 1.45 [95% CI, 0.70-3.18]; P = .343). Conclusions This study demonstrated that a PBQ score ≥2 has a higher yield for detecting children at risk for posttonsil surgery bleeding as compared with coagulation studies.

show abstract

Predicting Operative Bleeding in Elective Pediatric Surgeries Using the Pediatric Bleeding Questionnaire (PBQ)

Cited by 7 publications

References 20 publications

Diagnosing type 1 von Willebrand disease: good for patient's health or for doctor's prestige?: comment

Diagnosing type 1 von Willebrand disease: good for patient's health or for doctor's prestige?: comment

Predicting early and delayed bleedings in children who undergo adeno‐tonsillectomy surgery. Is it really possible?

Utility of the Pediatric Bleeding Questionnaire in Predicting Posttonsillectomy Bleeding

Contact Info

Product

Resources

About