Relationships between bleeding assessment tools (ISTH-BAT, Self-BAT) and quality of life in patients with bleeding symptoms.

BACKGROUND

The clinician-administered ISTH bleeding assessment tool (ISTH-BAT) and its self-report counterpart (self-BAT) were developed to standardize and quantify bleeding history. How BATs relate to overall clinical assessment and quality of life (QoL) is uncertain.

METHODS

A cross-sectional analysis of the ISTH-BAT, self-BAT, and PROMIS-29 QoL instruments was performed in 101 adult patients referred for bleeding disorder evaluation. We assessed reliability/agreement (Krippendorf's α) and diagnostic test characteristics of the ISTH-BAT and self-BAT. Linear regression models were used to evaluate the association between BATs and QoL domains, measured as standardized Z-scores.

RESULTS

Surveyed patients received the following diagnoses: Bleeding disorder of unknown cause (n = 46, 45.5%), qualitative platelet defect (n = 11, 10.9%), von Willebrand disease (n = 9, 8.9%), hypodysfibrinogenemia (n = 1, 1.0%), other/unclassified (n = 13, 12.9%), and no bleeding disorder (n = 21, 20.8%). The mean ISTH-BAT score was 8.1 (SD = 4.8), compared with a mean self-BAT score of 9.1 (SD = 5.8). Reliability between the ISTH-BAT and self-BAT was moderate/high for postpartum hemorrhage (α = 0.79) and menstrual bleeding (α = 0.69) and lowest for hemarthrosis (α = 0.26). The self-BAT had a sensitivity of 79.7% and specificity of 53.1% for an abnormal ISTH-BAT. Adjusting for age and sex, a higher ISTH-BAT (and similarly self-BAT) was associated with impairments in fatigue (β = -0.07, [95% CI, -0.12 to -0.02]), social roles (β = -0.07, [95% CI, -0.11 to -0.03]), sleep (β = -0.04, [95% CI, -0.08 to -0.009]), pain interference (β = -0.06, [95% CI, -0.11 to -0.02]), and physical function (β = -0.07, (95% CI, -0.11 to -0.04]).

CONCLUSION

Regardless of diagnosis, higher ISTH-BAT and self-BAT scores are associated with QoL impairments. Self-BAT items may be meaningful surrogates for clinician assessment of heavy menstrual bleeding and postpartum hemorrhage, although domain-level reliability is variable.