Reliability and Feasibility of the Self-Administered ISTH-Bleeding Assessment Tool

Abstract

Introduction Standardized bleeding assessment tools (BATs), such as the International Society for Thrombosis and Hemostasis (ISTH)-BAT, are screening instruments used during the diagnostic workup of suspected bleeding disorders. A self-administered ISTH-BAT (self-BAT) would enhance screening and save time during an outpatient clinic visit. Aim This study was aimed to investigate the reliability and feasibility of the self-BAT. Methods The electronic self-BAT was created from the ISTH-BAT and paper-version of self-BAT and optimized by patients and physicians. Patients with a (suspected) congenital platelet defect (CPD), who had previously undergone physician-administered ISTH-BAT assessment, were invited to complete the self-BAT. Optimal self-BAT cut-off values to detect a bleeding tendency, as defined by the ISTH-BAT, were evaluated by receiver operator characteristic (ROC) curve analysis to reach a sensitivity ≥95%. Reliability was tested by assessing sensitivity, specificity, and intraclass correlation (ICC). Feasibility was evaluated on comprehension and length of self-BAT. Results Both versions of the BAT were completed by 156 patients. Optimal cut-off values for self-BAT to define a bleeding tendency were found to be identical to those of the ISTH-BAT. Normal/abnormal scores of the ISTH-BAT and self-BAT were agreed in 88.5% (138/156, 95% confidence interval [CI]: 0.83–0.93) of patients. The sensitivity and specificity of the self-BAT to detect a bleeding tendency were 96.9 and 48.1%, respectively. The ICC was 0.73. Self-BAT questions were graded by 96.8% (151/156) as “very easy,” “easy,” and “satisfactory” and questionnaire length as “exactly right” by 91% (142/156) of patients. Conclusion In patients with a (suspected) CPD, the self-BAT is sufficiently reliable and feasible to detect a bleeding tendency, which supports its use as a screening tool.

Translation, validation, and usability of the International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (Self‐ISTH‐BAT)

“…Another explanation could be that the tools are not identical, and therefore, differences in question and scoring can lead to discrepancies. Nevertheless, a 3% misclassification is comparable to previous findings, 14 and we expect that the expert‐ISTH‐BAT can also be erroneous in few cases.…”

“…However, the ISTH‐BAT is expert‐administered (expert‐ISTH‐BAT) and should be filled out by healthcare practitioners with knowledge of bleeding disorders, which limits its use as a general screening tool. A patient‐administered version of the expert‐ISTH‐BAT (self‐ISTH‐BAT) is developed 12 and has been validated on individuals suffering from VWD, 12 hemophilia, 13 and congenital platelet defect (CPD) 14 along with the general population 15 . The self‐ISTH‐BAT is in English and therefore not applicable in non–English‐speaking countries.…”

“…The self‐ISTH‐BAT is in English and therefore not applicable in non–English‐speaking countries. A Dutch version of the self‐ISTH‐BAT has been reported and compared with expert‐ISTH‐BAT in individuals with suspected CPD 14 . However, to the best of our knowledge, no study has investigated whether self‐ISTH‐BAT can be used as a general screening tool in individuals attending hospital, by comparing self‐ISTH‐BAT and expert‐ISTH‐BAT in unselected individuals attending hospital.…”

Women and girls with heavy menstrual bleeding and inherited bleeding disorders: A call to action for the Haemophilia Treatment Centre Nurse

“…Use of tools in the clinical setting was thought to be cumbersome and time‐consuming prompting development of a tool designed for self‐administration. The self‐administered BAT has been deemed reliable and feasible to evaluate for an underlying bleeding disorder 27 . Overall, the BAT tools show better sensitivity than specificity and higher negative predictive value 28 .…”

Diagnosis of haemophilia and other inherited bleeding disorders ‐ Is a new paradigm needed?

“…A recent study also showed that it was discriminatory in haemophilia as well 23 . In fact, the self‐assessed BAT has also been shown to be as effective in screening for abnormal bleeding as the healthcare professional administered BAT 24 . So it is possible to imagine a situation where a validated self‐assessed BAT is given to all school children for their parents to provide the responses.…”