ISTH-SSC Bleeding Assessment Tool (ISTH-SCC BAT)

Who created it:
The ISTH/SSC Joint VWF and Perinatal/Pediatric Hemostasis Subcommittees Working Group — led by Rodeghiero, Tosetto, Abshire, Arnold, Coller, James, Neunert, and Lillicrap. The group formed at the 53rd SSC Annual Meeting in Geneva (2007) and met regularly afterward, first convening in Toronto in January 2008. Additional contributors came from a Menorrhagia Working Group under the Women's Issues SSC.

What it is:
A standardized questionnaire and companion scoring system (the "Bleeding Score," or BS) designed to structure and quantify a patient's bleeding history — covering everything from epistaxis and bruising to surgical bleeding, menorrhagia, postpartum hemorrhage, and CNS bleeds. It's meant for use in both children and adults with suspected inherited bleeding disorders.

Why they made it:
Existing bleeding assessment tools had two main gaps: they lacked pediatric-specific symptoms, and they overweighted symptom severity while ignoring frequency. The working group wanted a single, standardized tool that could be validated consistently across studies, rather than having researchers each use their own ad hoc questionnaires.

How it works:

• A physician or trained health professional administers the questionnaire, asking about symptoms and treatments occurring before or at diagnosis only.

• For each of 14 symptom categories, specific "minimal criteria" define what counts as clinically significant (vs. trivial) — e.g., epistaxis only counts if it lasts 10+ minutes, happens 5+ times/year, or isn't explained by an obvious cause.

• Each category is then scored 0–4 based on severity of intervention needed (nothing → consultation only → medical treatment → transfusion/surgery), using the detailed scoring grid (see the section Configuration).

• The individual category scores sum into an overall Bleeding Score, intended to help discriminate real bleeding disorders from normal variation, and to standardize reporting across future validation studies.

Configuration

There are are 14 possible questions or bleeding assessment domains that are assessed based on gender and age.

1. Adult Male (≥18 years): All questions (below) except questions #9 (Menorrhagia), #10 (Post Partum Hemorrhage) & #14 (Other bleeding).

2. Adult Female (≥18 years): All questions (below) except question #14.

3. Female Child (<18 years): All questions (below).

4. Male Child (<18 years): All questions (below) except questions #9 (Menorrhagia), & #10 (Post Partum Hemorrhage).

Note: The difference between 0 and 1 is important. A score of 1 means that the symptom is judged as present in the patient’s history by the interviewer but does not qualify for a score 2 or more.

* Consultation only: the patient sought medical evaluation and was either referred to a specialist or offered detailed laboratory investigation.

** E.g., 1 extraction/surgery resulting in bleeding (100%): the score to be assigned is 2; 2 extractions/surgeries, 1 resulting in bleeding (50%): the score to be assigned is 2; 3 extractions/surgeries, 1 resulting in bleeding (33%): the score to be assigned is 2; 4 extractions/surgeries, 1 resulting in bleeding (25%): the score to be assigned is 1.

*** If already available at the time of collection.

Results & Interpretation

• Low scores are associated with a low likelihood of a bleeding disorder, and additional evaluation may not be warranted.

• Elevated scores indicate an increased risk of bleeding; Consider further diagnostic evaluation for an underlying inherited bleeding disorder as appropriate (e.g., laboratory studies, specialty consultation).

• Results are not diagnostic but play a part of a comprehensive evaluation in conjunction with clinical judgment and specialty consultation.

• Recommended for use in patients with a suspected inherited bleeding disorder.

• Only symptoms and treatment BEFORE and AT diagnosis should be considered.