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Grading of hemorrhage in children with idiopathic thrombocytopenic purpura

Authors
Journal
The Journal of Pediatrics
0022-3476
Publisher
Elsevier
Volume
141
Issue
5
Identifiers
DOI: 10.1067/mpd.2002.128547
Disciplines
  • Design

Abstract

Abstract Objective: To develop an instrument to allow semiquantitative assessment of hemorrhage in children with idiopathic thrombocytopenic purpura (ITP). Study design: Bleeding severity was graded on a scale of 0 to 4 in 4 different sites (overall, oral, epistaxis, and skin) on the basis of history during the previous 24 hours and physical examination. Results: Children with ITP (n = 54) were assessed on 109 different occasions by multiple observers, including 81 measurements by one of the authors. Grade of bleeding correlated inversely with platelet count. Grade 3 or 4 hemorrhage was infrequently encountered except involving the skin, where assessment was difficult. Grade 4 mucosal or internal hemorrhage was noted in 7 patients; none had life-threatening or fatal bleeding. Interrater agreement in grading of overall and mouth bleeding and epistaxis was acceptable. Conclusions: We conclude that scoring of hemorrhage is possible in children with ITP and that the grade of hemorrhage may represent a clinically meaningful end point in future studies. (J Pediatr 2002;141:683-8)

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