ISTH Bleeding Assessment Tool

ISTH Bleeding Assessment Tool

International Society on Thrombosis and Haemostasis/Scientific and Standardization Committee Bleeding Assessment Tool (ISTH BAT)

Rodeghiero F, Tosetto A, Abshire T, Arnold DM, Coller B, James P, Neunert C, Lillicrap D on behalf of the ISTH/SSC Joint VWF and Perinatal/Pediatric Haemostasis Subcommittees Working Group

Questionnaire and scoring sheet

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

The ISTH BAT is intended to be used in children and adults to diagnose mild bleeding disorders. The target population is patients who are being evaluated for a bleeding disorder for the first time.1

Contact person:
F Rodeghiero: [email protected]
ISTH-BAT Standing Committee:

Date of this review: August 20, 2013
Updated: April, 2014

Overall utility:

Useful in the clinical setting of ruling out VWD in adults and children, or assessing for possible platelet dysfunction.


  • Few validation studies in total and very few subtypes of patients studied
  • Has never been validated for the assessment of a suspected bleeding disorder in adults
  • Requires a skilled professional to administer

1.  Time to complete: 20 minutes

2.  Equipment/space required: None

3.  Training required: Expert-administered; no training specific to the administration of the scoring tool is required

4.  Cost: None

5.  Scoring/scaling/interpretation of results:

  • Scale: 0–4 for each of 14 symptoms
  • Possible range of total score: 0–56
  • Differentiating features: Pediatric specific bleeding symptoms included in the “other bleeding” category
  • Abnormal bleeding score (BS): not identified

Psychometric properties:

1.  Construct validity:

Convergent validity

Divergent validity

  • No difference in bleeding score (BS) between healthy controls and subjects with heritable dysfibrinogenemia (i.e. not useful in disease with mild bleeding or no bleeding phenotype).4

Group differences

  • BSs were higher in possible platelet disorders than no bleeding disorder or mild factor deficiencies. Type 1/2 VWD was also distinguishable from mild factor deficiencies.2
  • BSs were higher in subjects being evaluated for possible platelet function disorder as compared to healthy controls.3

2.  Criterion validity:

  • Median BS was able to distinguish between type 1 or 2 VWD versus other diagnoses.2

3.  Reliability:

  • No reliability studies have been reported

4.  Responsiveness/sensitivity:

  • Ability to detect any mild bleeding disorder in the child when this tool was used to assess the symptoms in either the family of the child or the child being investigated (ROC-AUC of 0.764).2
  • Inability to detect laboratory proven platelet defects (ROC AUC of 0.5).3

Languages studied: English3,4, German2

Groups tested with this measure:

  • Children being evaluated for suspected bleeding disorder
  • Heritable dysfibrinogenemia
  • Controls (“healthy hospital staff”)

Age: Children and adults

  1. Rodeghiero F et al. ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders. J Thromb Haemost 2010; 8: 2063-2065 (plus supplementary material).
  2. Bidlingmaier C et al. Prospective evaluation of a pediatric bleeding questionnaire and the ISTH bleeding assessment tool in children and parents in routine clinical practice. J Thromb Haemost 2012; 10: 1335-1341.
  3. Lowe G et al. Utility of ISTH bleeding assessment tool in predicting platelet defects in participants with suspected platelet function disorders. J Thromb Haemost 2013 (in press).
  4. Shapiro SE et al. Clinical phenotype, laboratory features and genotype of 35 patients with heritable dysfibrinogenaemia. Br J Haematol 2013; 160: 220-227.