Description

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(s):
CS Philipp: [email protected]

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

Utility

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).

Administration

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:
     1. The duration of menses was ≥7 days and the woman reported either “flooding” or impairment of daily activities with most periods;
     2. A history of treatment of anemia;
     3. A family history of a diagnosed bleeding disorder;
     4. A history of excessive bleeding with tooth extraction, delivery or miscarriage, or surgery.

Psychometrics

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

Glossary of Psychometric Properties

References

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.