BLEEDING. Introduction. Starship Children s Health Clinical Guideline. Introduction Bleeding Questionnaire. Scoring Key References

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Allyson Kennedy
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1 te: The electronic version of this guideline is the version currently in use. Any printed version can Introduction Bleeding Questionnaire Scoring Key References Introduction This bleeding questionnaire is a tool designed to ensure a comprehensive bleeding history has been obtained and to help decide which patients should be considered for investigation of a bleeding tendency. The most common bleeding condition in children is trauma, and after that immune thrombocytopenia. The commonest inherited bleeding disorder is von Willebrand disease which is symptomatic in approximately 1:1000 people. The questionnaire has been validated for von Willebrand disease but is likely to be applicable to a wider range of platelet function disorders. A negative score is 2 or less and in most circumstances this would preclude investigation or referral of the child to a haematologist. If there are further questions about the questionnaire please refer to Dr Nyree Cole ( ) or Dr Lochie Teague ( ) at Starship. Bleeding Page: 1 of 9

2 te: The electronic version of this guideline is the version currently in use. Any printed version can Paediatric Bleeding Questionnaire Patient Information: Ethnic Background: Presenting Complaint of bleeding or bruising today? Personal history of bleeding or bruising Ever been diagnosed with a bleeding disorder? which diagnosis Family history of bleeding (at least one family member) what was the diagnosis? Pedigree (draw) Are you currently taking oral contraceptive pills? which brand? Are you pregnant? gestation Bleeding Page: 2 of 9

3 te: The electronic version of this guideline is the version currently in use. Any printed version can Specify any herbals and/or medications that you have taken in the past 30 days Name Dose route frequency duration sebleeds: Number of episodes per year < >12 Duration of average episode < 1 minute 1-10 minutes >10 minutes Cauterization/Packing Antifibrinolytic DDAVP /Replacement Bruising: Location: Exposed Sites Un-exposed Sites Size of average <1cm 1-5cm >5cm Minimal or no trauma please specify Bleeding Page: 3 of 9

4 te: The electronic version of this guideline is the version currently in use. Any printed version can Bleeding from minor wounds: Number per year <1 1-5 >6 Duration of average episode <5 minutes >5 minutes Medical Attention? Oral Cavity Bleeding: Surgical haemostasis /DDAVP/ Tooth eruption Gums, spontaneous Gums, after brushing Bites to lip and tongue Surgical haemostasis Post Dental Extraction: bleeding in at least 2 extractions ne done or bleeding in 1 extraction Medical Attention? Resuturing or packing Bleeding Page: 4 of 9

5 Gastrointestinal bleeding: Starship Children s Health Clinical Guideline te: The electronic version of this guideline is the version currently in use. Any printed version can Ulcer, portal hypertension, haemorrhoids Spontaneous Surgery//DDAVP/Antifibrinolytic Surgery: bleeding in at least 2 surgeries ne done, or no bleeding in 1 surgery Post-op medical attention? Surgical haemostasis Menorrhagia: Duration of average period days Duration of heavy menstruation days How often do you change your pads/tampons On heaviest days hours On average days hours Pill use/ Dilatation and Curettage Iron Hysterectomy Bleeding Page: 5 of 9

6 te: The electronic version of this guideline is the version currently in use. Any printed version can Post-Partum Haemorrhage: bleeding in at least 2 deliveries deliveries, or no bleeding in 1 delivery D&C/Iron /Antifibrinolytic Hysterectomy Muscle Haematomas: Post-trauma, no Spontaneous, no Spontaneous or traumatic with DDAVP/Replacement Spontaneous or traumatic requiring surgery or transfusion Haemarthrosis: Post-trauma, no Spontaneous, no Spontaneous or traumatic with DDAVP/Replacement Spontaneous or traumatic requiring surgery or transfusion Central Nervous System Bleeding: Subdural, any intervention Intracerebral, any intervention Bleeding Page: 6 of 9

7 te: The electronic version of this guideline is the version currently in use. Any printed version can Other bleed: specify site Umbilical stump Cephalohaematoma Bleeding at circumcision Venepuncture bleeding Suction bleeding Macroscopic haematuria Surgical haemostasis Bleeding Page: 7 of 9

8 te: The electronic version of this guideline is the version currently in use. Any printed version can Scoring Key Symptom Epistaxis Cutaneous Bleeding from Minor Wounds Oral Cavity Tooth Extraction GI Bleeding Surgery Menorrhagia Post-Partum Haemorrhage Muscle Haematomas Haemarthrosis CNS Bleeding Other Score bleeding in at least 2 extractions bleeding in at least 2 surgeries bleeding in at least 2 deliveries or trivial (<5) or trivival (<1cm) or trivial (<5) ne done or no bleeding in 1 extraction n done or no bleeding in 1 surgery >5 or more than 10 mins >1cm and no trauma >5 or more than 5 mins Referred at least once Reported, no consultation Associated with ulcer, portal hypertension, haemorrhoids, angiodysplasia Reported, no consultation Spontaneous Antifibrinolytics, pill use ne or no bleeding after 1 baby Never Never Never Post trauma, no Post trauma, no D&C, iron, s Spontaneous, no Spontaneous, no Packing or cautery or Surgical haemostasis Surgical haemostasis or Resuturing or packing Surgical haemostasis, blood transfusion,, DDAVP, Surgical haemostasis or D&C, iron, ablation Blood transfusion or DDAVP or Spontaneous or traumatic requiring DDAVP or Spontaneous or traumatic requiring DDAVP or Subdural, any intervention Reported Surgical haemostasis, or iron or hysterectomy hysterectomy Spontaneous or traumatic requiring surgical intervention or blood transfusion Spontaneous or traumatic requiring surgical intervention or blood transfusion Intracerebral, any intervention, or desmopressin Bleeding Page: 8 of 9

9 te: The electronic version of this guideline is the version currently in use. Any printed version can For von Willebrand Disease and a Score 2 Sensitivity = 84% Specificity = 75% Positive Predictive Value 0.15 Negative Predictive Value 0.99 A bleeding score of 2 has a likelihood ration of 3.5 ( ) References Bowman m, Riddel J, Rand ML, Tosetto A, Silva M and James PD. Evaluation of the diagnostic utility for von Willebrand disease of a paediatric bleeding questionnaire. J Thromb Haemost 2009; 7: Bleeding Page: 9 of 9

Pediatric Bleeding Questionnaire (PBQ)

Pediatric Bleeding Questionnaire (PBQ) Date Patient Number Patient Name Gender Male Female Age DOB (dd/mm/yy) Ethnic Background of: Father Mother Presenting complaint of bleeding or bruising today? Ever been diagnosed with a bleeding disorder?