Department of Obstetrics & Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands.
Department of Methodology and Statistics, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands.
BJOG. 2017 Jan;124(2):277-282. doi: 10.1111/1471-0528.14434.
The Pictorial Blood Loss Assessment Chart (PBAC) is a validated tool that is used to diagnose heavy menstrual bleeding (HMB). Knowledge of the effect of its score and its relationship with outcome could have implications for using the PBAC as an outcome measurement in future HMB studies, and as a tool to evaluate the treatment effect in research and clinical practice. Our aim was to relate PBAC scores to other measures of success after endometrial ablation for HMB.
Analysis of individual patient data (IPD) of randomised controlled trials studying women with HMB.
Women with HMB consulting their gynecologists.
Individual patient data (IPD) of randomised controlled trials studying women with HMB.
We included studies if they had studied second-generation endometrial ablation techniques and had collected PBAC scores for both baseline and follow-up. The effectiveness of treatment was scored as satisfaction or re-intervention (yes/no) 12 months after treatment. We related these outcomes to the PBAC score at 12 months after treatment, and to PBAC decrease between baseline and 12 months of follow-up.
We studied data for 900 patients included in nine studies. The median PBAC score at 12 months was 7 (0-2500). The overall satisfaction rate was 89% and the overall re-intervention rate was 7.2%. A clear association was found between absolute PBAC score at the 12-month follow-up and satisfaction (odds ratio, OR 0.16; 95% confidence interval, 95% CI 0.11-0.24) and surgical re-intervention (OR 2.3, 95% CI 1.8-2.8). A change in PBAC score was also associated with satisfaction (OR 2.0, 95% CI 1.7-2.3) and surgical re-intervention (OR 0.69, 95% CI 0.63-0.75). Both the absolute PBAC scores and the changes in score show high accuracy for both treatment outcomes.
PBAC scores at 12 months after treatment are significantly associated with satisfaction and re-intervention rates. We propose to use the PBAC in research as a primary end point in studies on HMB, and in clinical practice as a measure to assess the effectiveness of treatment.
PBAC scores 12 months after treatment are significantly associated with satisfaction and reintervention rates.
Pictorial Blood Loss Assessment Chart（PBAC）是一种经过验证的工具，用于诊断月经过多（HMB）。了解其评分的影响及其与结果的关系，可能对未来 HMB 研究中将 PBAC 用作结局测量以及在研究和临床实践中评估治疗效果具有重要意义。我们的目的是将 PBAC 评分与子宫内膜消融术治疗 HMB 后的其他成功指标联系起来。
对研究 HMB 女性的随机对照试验的个体患者数据（IPD）进行分析。
患有 HMB 的女性向妇科医生咨询。
接受 HMB 治疗的女性的个体患者数据（IPD）。
如果研究使用了第二代子宫内膜消融技术，并为基线和随访收集了 PBAC 评分，则我们将这些研究纳入。治疗 12 个月后的治疗效果评分标准为满意度或再次干预（是/否）。我们将这些结果与治疗后 12 个月的 PBAC 评分以及 PBAC 在基线和 12 个月随访期间的下降情况联系起来。
我们研究了 9 项研究中纳入的 900 名患者的数据。治疗后 12 个月时的 PBAC 评分中位数为 7（0-2500）。总体满意度为 89%，总体再次干预率为 7.2%。在治疗后 12 个月的随访中，绝对 PBAC 评分与满意度（比值比，OR 0.16；95%置信区间，95%CI 0.11-0.24）和手术再次干预（OR 2.3，95%CI 1.8-2.8）之间存在明显关联。PBAC 评分的变化也与满意度（OR 2.0，95%CI 1.7-2.3）和手术再次干预（OR 0.69，95%CI 0.63-0.75）相关。治疗后 12 个月时的绝对 PBAC 评分和评分变化对两种治疗结局均具有较高的准确性。
治疗后 12 个月时的 PBAC 评分与满意度和再干预率显著相关。我们建议在 HMB 研究中将 PBAC 用作研究中的主要终点，并在临床实践中将其用作评估治疗效果的指标。
治疗后 12 个月时的 PBAC 评分与满意度和再干预率显著相关。
