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Menorrhagia-Specific Screening Tool

 
Menorrhagia-Specific Screening Tool
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Menorrhagia-Specific Screening Tool

Authors/developers
Philipp CS, Faiz A, Dowling NF, Beckman M, Owens S, Ayers C, Bachmann G

Questionnaire
Scoring key

N.B.: These scores are posted with the permission of the developers.
  • Description
  • Utility
  • Administration
  • Psychometrics
  • References

A short, easy-to-use tool to help identify women with unexplained menorrhagia who require further laboratory investigations. The target population is women with menorrhagia.

Contact person:
CS Philipp: philipp@rwjms.rutgers.edu

Date of this review: August 26, 2013
Updated: April, 2014

Overall utility:

  • Useful in the clinical setting of stratifying those with menorrhagia complaints that need further laboratory evaluation
  • Could be improved by incorporating the pictoral blood assessment chart (PBAC)

Limitations:

  • Poor specificity, therefore a lot of subjects would be tested that do not have an underlying disorder.
  • Difficult to assess validity as studies done to date do not contain a control population (no menorrhagia) and the prevalence of underlying bleeding disorders in the study populations was very high (higher than the normal population).

1 . Time to complete: 5–10 minutes

2.  Equipment/space required: None

3.  Training required: Not identified

4.  Cost: None

5.  Scoring/scaling/interpretation of results:

  • Scale of 0 or 1 for each of 8 symptoms
  • Possible range of total score 0–8
  • Abnormal bleeding score (BS) if 1 of the following 4 criteria were met:
    a) The duration of menses was ≥7 days and the woman reported either “flooding” or impairment of daily activities with most periods;
    b) A history of treatment of anemia;
    c) A family history of a diagnosed bleeding disorder;
    d) A history of excessive bleeding with tooth extraction, delivery or miscarriage, or surgery.

Psychometric properties:

1.  Construct validity:

Convergent validity

  • The initial tool was made from a larger set of questions. Only questions that had a high proportion of concordance with an underlying bleeding disorder and overall good sensitivity were added to the final screening tool.1

2.  Criterion validity:

  • The screen was able to identify the majority of VWD cases through an abnormal bleeding score (BS).1

3.  Reliability:

  • No studies identified

4.  Responsiveness/sensitivity:

  • Abnormal BS can be used to identify those with/without a laboratory-defined bleeding disorder with a sensitivity of 82%, a specificity of 24%, a positive predictive value (PPV) of 71%, and a negative predictive value (NPV) of 38%. More specifically for VWD, sensitivity was 83% and specificity was 20%. When the Pictorial Blood Loss Assessment Chart (PBAC) score ≥100 and abnormal PFA-100 testing were added to the BS, the sensitivity increased to 95% and the specificity was similar at 16%, for a diagnosis of a laboratory-defined bleeding disorder.1
  • A second study showed a similar sensitivity of 89% and specificity of 16% (PPV of 72%, NPV of 37%) that again could be improved mostly with the addition of an abnormal PBAC >185, increasing the sensitivity to 95% for the diagnosis of an underlying bleeding disorder.2

Languages studied: English

Groups tested: Adolescent and adult women with menorrhagia1

Age: Adolescents and adults

  1. Philipp CS Evaluation of a screening tool for bleeding disorders in a US multisite cohort of women with menorrhagia. Am J Obstet Gynecol 2011; 204: 209.e1-7.
  2. Philipp CS Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation. Am J Obstet Gynecol 2008; 98: 163.e1-163.e8.