Utility of a screening tool for haemostatic defects in a multicentre cohort of adolescents with heavy menstrual bleeding.
Utility of a screening tool for haemostatic defects in a multicentre cohort of adolescents with heavy menstrual bleeding.
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在月经出血过多的青少年多中心队列中使用一种筛查工具来筛查止血缺陷。
DOI：
10.1111/hae.13609
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
O'Brien,SarahH
中科院分区：
文献类型：
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作者：
Zia,Ayesha;Stanek,Joseph;Christian-Rancy,Myra;Ahuja,SanjayP;Savelli,Stephanie;O'Brien,SarahH
月经初潮后，许多青少年可能会出现月经大出血（HMB）。HMB的准确评估，在诊断的止血缺陷（HD）的关键组成部分，是一个公认的challenge.AimOur的目的是要确定的诊断准确性的HMB特异性筛查工具HD的青少年HMB，提出了二级保健setting.MethodsAdolescents与HMB进行了评估HD在4个美国中心。一个筛选工具，菲利普工具，开发和验证的成年女性HMB，管理。我们修改了工具，根据肯定回答的数量分配分数。灵敏度，特异性和似然比（LR）的阳性工具，修改后的工具，一个图形化的血液评估表（PBAC）评分>185，血清铁蛋白≤20 ng/mL的HDs.ResultsAmong 248青少年HMB，29%被诊断为HD。HD阳性筛查工具的灵敏度、特异性和LR分别为95%（范围88 - 99）、14%（9 - 21）和1.1（1 - 1.2）。评分≥2，加上PBAC评分>185和铁蛋白≤20 ng/mL，将该工具的灵敏度、特异性和LR改变为72%（61 - 81）、94%（83 - 99）、76%（65 - 85）; 60%（53 - 68），24%（16 - 34）和39%（31 - 47）和1.8（1.4 - 2.2），1.2（1.1 - 1.4）和1.2（1 - 1.4），respectively。需要进一步的研究来优化或开发针对青少年的HMB工具，用于二级护理环境。
IntroductionHeavy menstrual bleeding (HMB) may be expected for many adolescents after menarche. Accurate assessment of HMB, a key component in the diagnosis of a haemostatic defect (HD), is a well‐recognized challenge.AimOur objective was to determine the diagnostic accuracy of an HMB‐specific screening tool for HDs in adolescents with HMB, presenting to a secondary care setting.MethodsAdolescents with HMB were evaluated for a HD at 4 US centres. A screening tool, the Philipp Tool, developed and validated in adult women with HMB, was administered. We modified the tool by assigning a score based on the number of affirmative responses. Sensitivity, specificity and likelihood ratios (LRs) of a positive tool, modified tool, with a pictorial blood assessment chart (PBAC) score >185, and with serum ferritin ≤20 ng/mL were calculated for HDs.ResultsAmong 248 adolescents with HMB, 29% were diagnosed with HDs. Sensitivity, specificity and LR of a positive screening tool for HDs were 95% (range 88‐99), 14% (9‐21) and 1.1 (1‐1.2), respectively. A score of ≥2, addition of a PBAC score >185 and ferritin ≤20 ng/mL changed the sensitivity, specificity and LR of the tool to 72% (61‐81), 94% (83‐99), 76% (65‐85); 60% (53‐68), 24% (16‐34) and 39% (31‐47) and 1.8 (1.4‐2.2), 1.2 (1.1‐1.4) and 1.2 (1‐1.4), respectively.ConclusionAlthough sensitive, the discriminative ability of the tool to identify adolescents with HDs from those without, who presented with HMB, was low. Further research is needed to optimize or develop an adolescent‐specific HMB tool for secondary care settings.