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Pediatric Bleeding Questionnaire (PBQ)

Authors/developers

Bowman M, Riddel J, Rand ML, Tosetto A, Silva M, James PD

Questionnaire and scoring key

N.B.: These scores are posted with the permission of the developers.

[/vc_column_text][mpc_tabs preset=”mpc_preset_11″ tabs_position=”left” active_tab=”0″ decor_line=”true” decor_color=”#616265″ decor_active=”#616265″ decor_size=”2″ decor_gap=”10″ font_preset=”preset_0″ font_color=”#888888″ font_size=”14″ font_line_height=”1.75″ font_align=”left” content_padding_divider=”true” content_padding_css=”padding-top:20px;padding-right:0px;padding-bottom:10px;padding-left:0px;” background_color=”#f7f7f7″ padding_css=”padding:30px;” margin_divider=”true” margin_css=”margin-right:10px;margin-left:20px;” mpc_button__font_preset=”preset_1″ mpc_button__font_color=”#e31837″ mpc_button__font_size=”16″ mpc_button__font_transform=”none” mpc_button__font_align=”left” mpc_button__border_divider=”true” mpc_button__border_css=”border-radius:15px;” mpc_button__padding_divider=”true” mpc_button__padding_css=”padding-right:20px;padding-left:20px;” mpc_button__hover_font_color=”#ffffff” mpc_button__hover_background_color=”#008bb0″ mpc_button__hover_background_effect=”expand-horizontal” mpc_button__hover_border_divider=”true” mpc_button__hover_border_css=”border-radius:0px;” button_margin_divider=”true” button_margin_css=”margin-right:0px;margin-left:0px;”][mpc_tab title=”Description” tab_id=”1468785295-1-20b60e-72e13c95-2e8a”][vc_column_text css=”.vc_custom_1486397224478{margin-left: 0px !important;border-left-width: 0px !important;padding-left: 20px !important;}”]A pediatric-specific bleeding questionnaire used as a screening tool for VWD.The target population is children with VWD.

Contact person:
PD James: [email protected]

Date of this review: August 25, 2013
Updated: April, 2014[/vc_column_text][/mpc_tab][mpc_tab title=”Utility” tab_id=”1468785295-2-99b60e-72e13c95-2e8a”][vc_column_text css=”.vc_custom_1475154967523{padding-left: 20px !important;}” el_class=”arrow”]Overall utility:

• Most useful in the pediatric clinical setting to assess which children should be further evaluated for VWD
• May also be useful in platelet function disorders
• May be used as a self-administered tool once validated appropriately
• Quick and easy to use

Limitations:

Very few studies documented a need for the pediatric specific bleeding symptoms in the “other” category, therefore the need for them is unclear.[/vc_column_text][/mpc_tab][mpc_tab title=”Administration” tab_id=”1468785421664-2-2b60e-72e13c95-2e8a”][vc_column_text css=”.vc_custom_1478795819858{padding-left: 20px !important;}” el_class=”arrow”]

1. Time to complete: 20 minutes
2. Equipment/space required: None
3. Training required: Physician, research nurse or research associate (“trained expert”) administered. One study utilized a self-administered version of the PBQ.⁵
4. Cost: None
5. Scoring/scaling/interpretation of results:

• Scale –1 to 4 for 2 categories of the 13 symptoms tested: dental extraction and surgery. Maximum score for cutaneous bleeding is 2; maximum score for gastrointestinal tract or post-partum bleeding is 3; score of –1 is assigned for lack of bleeding on 2 or more challenges for each of post-surgery bleeding, post-partum hemorrhage, and bleeding post-tooth extraction.
• Possible range: –3 to 48
• Differential features include modification to include pediatric-specific bleeding symptoms in the “other category” (post-circumcision bleeding, umbilical stump bleeding, cephalohematoma, macroscopic hematuria, post-venipuncture bleeding, conjunctival hemorrhage)
• Abnormal bleeding score (BS) ≥2

[/vc_column_text][/mpc_tab][mpc_tab title=”Psychometrics” tab_id=”1468785430492-3-3b60e-72e13c95-2e8a”][vc_column_text css=”.vc_custom_1475155942213{padding-top: 10px !important;padding-bottom: 10px !important;padding-left: 20px !important;}” el_class=”arrow”]Psychometric properties:

1.  Construct validity:

Convergent validity

• 32% of boys with VWD scored a clinically significant bleeding score (BS) with post-circumcision bleeding.²
• 96% of children with a platelet function disorder scored a positive BS.⁴
• BS was inversely related to VWF:Ag and VWF:RCo when using a self-administered version of the PBQ.⁵
• BS was significantly higher in affected vs. unaffected family members with VWD.⁶

Group differences

• Abnormal BS was derived from assessment of questionnaire in a general control population of children attending school association meetings. The normal range of BS was between –1.5 to 2.5 and only 13% had a score ≥2.¹
• Median BS was significantly different between children with VWD > positive BS without VWD > negative BS without VWD.¹
• Median BS was significantly higher in all forms of VWD vs. controls as well as all forms of definite VWD vs. possible VWD.²

2.  Criterion validity:

• For the laboratory diagnosis of VWD, the BS was able to accurately differentiate between those affected and unaffected with VWD.¹

3.  Reliability:

• Repeat testing was performed in one study but results were not recorded.²

4.  Responsiveness/sensitivity:

• Responsiveness by means of ROC analysis had an AUC of 0.88.¹
• Responsiveness of tool to increased BS with increasing age was shown (Spearman’s correlation coefficient was 0.35, p=0.0004).²
• The sensitivity of an abnormal BS for diagnosis of VWD was 83%, with a specificity of 79%, positive predictive value (PPV) of 0.14, and negative predictive value (NPV) of 0.99.¹
• When using a screening question of “Does your child have a problem with bleeding or bruising?” the sensitivity and specificity for a positive BS and diagnostically proven VWD was similar (sensitivity of 94% vs. 91% and specificity of 94% vs. 95%, respectively).
• Internal consistency of questions within one version of the self-PBQ was good, with a Crohnbach’s alpha of 0.88.⁵
• PBQ ROC-AUC was 0.768, similar to the ISTH BAT ROC-AUC of 0.764.⁸
• However, in a tertiary care setting when evaluating for a mild bleeding disorder, the PBQ was found to have an ROC-AUC<0.6 for qualitative BS cut off of 2:
  – Using a cut off of >2, hemorrhagic symptoms sensitivity was 60.5%, and specificity was 50.8%
  – Using a cut off of BS >3 in males and >5 in females, sensitivity was 41.9%, and specificity was 82%.⁷

Languages studied: English, German ⁸

Groups tested with this measure:

• Controls^1,2
• Children being evaluated for VWD because of personal or family history of bleeding^1,6
• Children with known diagnosis of VWD (type 1–3)^2,3,6,7
• Children with a known diagnosis of a platelet function disorder⁴
• Hemophilia A⁵

Age: Children and some adults

[/vc_column_text][/mpc_tab][mpc_tab title=”References” tab_id=”1468785442046-4-10b60e-72e13c95-2e8a”][vc_column_text css=”.vc_custom_1468892037465{padding-left: 20px !important;}”]

1. Bowman M et al. Evaluation of the diagnostic utility for von Willebrand disease of a pediatric bleeding questionnaire. J Thromb Haemost 2009; 7: 1418-1421.
2. Biss T et al. Quantitation of bleeding symptoms in children with von Willebrand disease: use of a standardized pediatric bleeding questionnaire. J Thromb Haemost 2010; 8: 950-956.
3. Bowman M et al. A Prospective Evaluation of the Prevalence of Symptomatic von Willebrand Disease (VWD) in a Pediatric Primary Care Population. Pediatr Blood Cancer 2010; 55: 171-173.
4. Biss T et al. Use of a quantitative pediatric bleeding questionnaire to assess mucocutaneous bleeding symptoms in children with a platelet function disorder. J Thromb Haemost 2010; 8: 1416-1419.
5. Boelaars MFP et al. Evaluation of a self-administrated pediatric bleeding questionnaire measuring bleeding severity in children. Thromb Haemost 2012; 108: 1006-1007.
6. Robertson J et al. Expanded phenotype–genotype correlations in a pediatric population with type 1 von Willebrand disease. J Thromb Haemost 2011; 9: 1752-60.
7. Marcus PD et al. The power of a standardized bleeding score in diagnosing paediatric type 1 von Willebrand’s disease and platelet function defects. Haemophilia 2011; 17: 223-227.
8. 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.

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