Evaluation of children with a suspected bleeding disorder applying the Impact-R [Cone and Plate(let) Analyzer] Export

@article{citeulike:5984173, abstract = {Summary. Background: A convenient screening test for children with bleeding symptoms before more labor-intensive diagnostic steps are taken would be of value. The Impact-R was designed in an attempt to analyse platelet function under near physiological conditions. Results are presented as surface coverage (SC, \%) and average size (AS, 03BCm2). Objective: In this cross-sectional retrospective study, we assessed the use of the Impact-R in the evaluation of children with a suspected bleeding disorder (BD). Methods: The hospital charts of 110 children referred to the coagulation laboratory were reviewed for personal and family bleeding history (BH) as well as results of the laboratory evaluation. Results: A laboratory 'diagnosable' BD (LBD) was found in 23 children (21\%, 95\% CI 14201330\%). A diagnosis of LBD was associated with the severity of bleeding but not with family BH. By receiver-operating characteristic (ROC) curve analysis, the SC was superior to the AS for diagnosis of a LBD. The Impact-R was abnormal in 43/97 children (44.3\%, 95\% CI 34201355\%). The predictive values of a normal and abnormal Impact-R were 96\% (95\% CI 92201397\%) and 42\% (95\% CI 28201356\%), respectively. When considering the personal and family BH, the post-test probability for LBD after a normal Impact-R was reduced from 20\% to 3.5\% (95\% CI 2.520137\%). Conclusions: A normal Impact-R test is highly effective in excluding LBDs. Yet, in case of an abnormal Impact-R test, further testing is needed. An algorithm that includes the personal and family BH and the results of a screening test may improve the diagnostic process. Prospective studies are now needed to confirm these findings.}, address = {Pediatric HematologyOncology Department; Coagulation Unit, Hadassah Hebrew-University Hospital; Hematology Unit, Bikur-Cholim Hospital; Pediatric Department, Hematology Unit, Shaare-Zedek Medical Center, Jerusalem, Israel}, author = {Revel-Vilk, S. and Varon, D. and Shai, E. and Agmon, Y. and Hyam, E. and Daas, N. and Miskin, H. and Weintraub, M.}, citeulike-article-id = {5984173}, citeulike-linkout-0 = {http://dx.doi.org/10.1111/j.1538-7836.2009.03628.x}, citeulike-linkout-1 = {http://www3.interscience.wiley.com/cgi-bin/abstract/122615545/ABSTRACT}, doi = {10.1111/j.1538-7836.2009.03628.x}, issn = {1538-7836}, journal = {Journal of Thrombosis and Haemostasis}, keywords = {children, cone, impact, platelet, platelet\_aggregation, platelet\_function, platelets}, number = {12}, pages = {1990--1996}, posted-at = {2009-10-22 09:13:56}, priority = {2}, title = {Evaluation of children with a suspected bleeding disorder applying the Impact-R [Cone and Plate(let) Analyzer]}, url = {http://dx.doi.org/10.1111/j.1538-7836.2009.03628.x}, volume = {7}, year = {2009} }

TY - JOUR ID - citeulike:5984173 L3 - citeulike-article-id:5984173 N2 - Summary. Background: A convenient screening test for children with bleeding symptoms before more labor-intensive diagnostic steps are taken would be of value. The Impact-R was designed in an attempt to analyse platelet function under near physiological conditions. Results are presented as surface coverage (SC, %) and average size (AS, 03BCm2). Objective: In this cross-sectional retrospective study, we assessed the use of the Impact-R in the evaluation of children with a suspected bleeding disorder (BD). Methods: The hospital charts of 110 children referred to the coagulation laboratory were reviewed for personal and family bleeding history (BH) as well as results of the laboratory evaluation. Results: A laboratory 'diagnosable' BD (LBD) was found in 23 children (21%, 95% CI 14201330%). A diagnosis of LBD was associated with the severity of bleeding but not with family BH. By receiver-operating characteristic (ROC) curve analysis, the SC was superior to the AS for diagnosis of a LBD. The Impact-R was abnormal in 43/97 children (44.3%, 95% CI 34201355%). The predictive values of a normal and abnormal Impact-R were 96% (95% CI 92201397%) and 42% (95% CI 28201356%), respectively. When considering the personal and family BH, the post-test probability for LBD after a normal Impact-R was reduced from 20% to 3.5% (95% CI 2.520137%). Conclusions: A normal Impact-R test is highly effective in excluding LBDs. Yet, in case of an abnormal Impact-R test, further testing is needed. An algorithm that includes the personal and family BH and the results of a screening test may improve the diagnostic process. Prospective studies are now needed to confirm these findings. IS - 12 JF - Journal of Thrombosis and Haemostasis SN - 1538-7836 AD - Pediatric HematologyOncology Department; Coagulation Unit, Hadassah Hebrew-University Hospital; Hematology Unit, Bikur-Cholim Hospital; Pediatric Department, Hematology Unit, Shaare-Zedek Medical Center, Jerusalem, Israel EP - 1996 TI - Evaluation of children with a suspected bleeding disorder applying the Impact-R [Cone and Plate(let) Analyzer] VL - 7 SP - 1990 KW - children KW - cone KW - impact KW - platelet KW - platelet_aggregation KW - platelet_function KW - platelets AU - Revel-Vilk, S AU - Varon, D AU - Shai, E AU - Agmon, Y AU - Hyam, E AU - Daas, N AU - Miskin, H AU - Weintraub, M PY - 2009/// UR - http://dx.doi.org/10.1111/j.1538-7836.2009.03628.x ER -