USEFULNESS OF PATIENT INTERVIEW IN BLEEDING DISORDERS

Background: It is not known which questions ina medical interview are most informative for diagnosing mild bleeding disorders, and what the value is of the entire interview in screening for hemostatic disorders . Methods: A questionnaire was sent to 222 patients with a proven blee ding disorder, to 134 patients suspected of a bleeding disorder but wh ose hemostasis proved normal, and to 341 healthy volunteers. A first c omparison, between patients with a bleeding disorder and patients with bleeding complaints whose hemostasis proved normal, mimics the situat ion in a department of hematology where patients are referred because of complaints. The second comparison, between patients with a proven b leeding disorder and healthy volunteers, may serve as a model for the situation where the interview is used as a screening tool to detect pa tients with a bleeding disorder in a population where there is no prio r suspicion, eg, before surgical intervention. For each question we ca lculated a univariate odds ratio, multivariate odds ratios, and a posi tive and negative likelihood ratio. With a receiver operating characte ristic curve analysis we evaluated the value of a simple vs an elabora te interview. Results: Ninety-two percent of the questionnaires were r eturned. For both comparisons the most informative questions were ques tions about bleeding disorders in the family and traumatic events, wit h the exception of delivery. Noninformative questions were frequent gu m-bleeds and blood in the urine. A receiver operating characteristic c urve analysis revealed that a simple interview has a high discriminati ng power in a screening situation, whereas in a referred situation eve n an elaborate interview has a low performance. Conclusions: A simple interview is useful as a screening tool for the dentist or surgeon. In a specialized hematology center with referred patients, however, the interview is of little value in identifying patients with a bleeding d isorder.