Buchanan George R, Adix Leah
Division of Hematology-Oncology, Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Texas, USA.
J Pediatr. 2002 Nov;141(5):683-8. doi: 10.1067/mpd.2002.128547.
To develop an instrument to allow semiquantitative assessment of hemorrhage in children with idiopathic thrombocytopenic purpura (ITP).
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.
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.
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.
开发一种工具，用于对特发性血小板减少性紫癜（ITP）患儿的出血情况进行半定量评估。
根据前24小时的病史和体格检查，对4个不同部位（总体、口腔、鼻出血和皮肤）的出血严重程度进行0至4级评分。
多名观察者对54例ITP患儿进行了109次不同的评估，其中一名作者进行了81次测量。出血分级与血小板计数呈负相关。除了皮肤出血评估困难外，3级或4级出血很少见。7例患儿出现4级黏膜或内出血；均无危及生命或致命性出血。总体、口腔出血和鼻出血分级的观察者间一致性尚可。
我们得出结论，ITP患儿的出血情况可以进行评分，并且出血分级可能在未来研究中代表一个具有临床意义的终点。
