Self-Administered Electronic Assessment Tool Helps Clinicians Screen for Pediatric Bleeding Disorders

Self-Administered Electronic Assessment Tool Helps Clinicians Screen for Pediatric Bleeding Disorders 1024 684 JoAnna Pendergrass, DVM
teen girl using cell phone

An electronic self-administered bleeding assessment tool is a time-saving measure to comprehensively evaluate a pediatric patient’s bleeding symptoms.

Bleeding assessment tools (BATs), originally developed as research tools, are used clinically to comprehensively evaluate a patient’s bleeding symptoms. Along with clinical judgement, “BATs are used to discriminate between patients who do and do not have a bleeding disorder,” explains Bryce Kerlin, MD, a principal investigator in the Center for Clinical & Translational Research at Nationwide Children’s Research Institute.

However, BATs are primarily paper-based, making their administration time-consuming and creating challenges for recording the BAT data in a patient’s electronic medical record (EMR).

Self-administered electronic BATs (eBAT) effectively address both of these difficulties.

A research team led by Sarah O’Brien, MD, director of Nationwide Children’s Young Women’s Hematology Clinic, conducted a study to evaluate the level of agreement between self-administered eBAT and physician-administered BAT (pBAT) scores for pediatric patients being evaluated for bleeding disorders at Nationwide Children’s hematology clinics.

Study results, recently reported in Haemophilia, demonstrated a strong, positive level of agreement between the scores.

Ninety-four patients, aged 0 to 21 years, were recruited for the study, which was conducted between December 2017 and November 2018.

“When approached, no one declined to participate and no one dropped out of the study,” remarks Dominder Kaur, MD, MSc, a former fellow in Nationwide Children’s Joan Fellowship in Pediatric Hemostasis-Thrombosis program and first author of the publication.

The study’s eBAT was a combination of the Self-Paediatric Bleeding Questionnaire and the International Society of Thrombosis and Haemostasis Bleeding Assessment Tool.

Patients were randomized to complete either the eBAT first then the pBAT, or vice versa. Bleeding scores were recorded in the patients’ EMRs.

Median completion times were 8 minutes for the eBAT (range, 2 to 28 minutes) and 10 minutes for the pBAT (range, 3 to 19 minutes).

Patients and their families reported that they generally enjoyed using the eBATs.

“Completing the eBAT before the appointment gave one family more time to think about details of the bleeding symptoms that they wouldn’t have otherwise remembered,” says Dr. Kaur.

The median bleeding scores for the eBAT and pBAT were 4, with a strong positive correlation between the scores. There was also a strong correlation between bleeding score and time to complete the eBAT.

Drs. Kerlin and O’Brien envision the eBAT being used more widely in the hematology clinic. “Having the eBAT would make the bleeding assessment more user-friendly for patients and clinicians,” says Dr. Kerlin.

With most patients being able to complete the eBAT in less than 10 minutes, Dr. O’Brien foresees the assessment being easily completed before a visit, either in the clinic’s waiting room or at home.

Self-administered eBAT data will eventually be collected within the electronic medical record. These data, Dr. Kerlin explains, can be used to retrospectively analyze how eBAT scores relate to a patient’s final diagnosis.

Dr. O’Brien notes the eBAT’s benefit for primary care physicians. Complaints of bleeding problems, such as heavy menses or nosebleeds, are common in the primary care setting, but providers may be unsure if the symptoms are abnormal. The eBAT, she says, could help primary care physicians determine whether a patient’s bleeding symptoms are normal or abnormal.


  1. Casey LJ, Tuttle A, Grabell J, et al. Generation and optimization of the self-administered pediatric bleeding questionnaire and its validation as a screening tool for von Willebrand disease. Pediatric Blood and Cancer. 2017 Oct;64(10). doi: 10.1002/pbc.26588.
  2. Kaur D, Kerlin BA, Stanek JR, O’Brien SH. Use of electronic self-administered bleeding assessment tool in diagnosis of paediatric bleeding disorders. Haemophilia. 2021 Jun 5. doi: 10.1111/hae.14349. Online ahead of print.



About the author

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. She received her veterinary degree from the Virginia-Maryland College of Veterinary Medicine and completed a 2-year postdoctoral research fellowship at Emory University’s Yerkes Primate Research Center before beginning her career as a medical writer.

As a freelance medical writer, Dr. Pendergrass focuses on pet owner education and health journalism. She is a member of the American Medical Writers Association and has served as secretary and president of AMWA’s Southeast chapter.

In her spare time, Dr. Pendergrass enjoys baking, running, and playing the viola in a local community orchestra.