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Global multicenter study establishes the reference range for ISTH Bleeding Assessment Tool scores in individuals under 18 years: communication from the SSC of the ISTH
Journal article   Open access   Peer reviewed

Global multicenter study establishes the reference range for ISTH Bleeding Assessment Tool scores in individuals under 18 years: communication from the SSC of the ISTH

Yousra Tera, Ryan Babensee, Ahmad Ekhtiar, Ahmad Darwish, Helen Okoye, Margareth C. Ozelo, Mozah Al Marshood, Munira Borhany, Elvira Grandone, Jim Riddel, …
Journal of thrombosis and haemostasis
2026
DOI: https://doi.org/10.1016/j.jtha.2026.07.028
PMID: 42586319
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Open Access CC BY V4.0

Abstract

age factors hemorrhage pediatrics reference values sex factors
The International Society on Thrombosis and Haemostasis (ISTH) Bleeding Assessment Tool (BAT) is widely used to screen for inherited bleeding disorders. Adult reference ranges are age- and sex-specific. However, a single reference range (0-2) is currently applied to all individuals under 18 years. Adolescent developmental changes and global differences in healthcare access may influence bleeding scores, necessitating validation in a large international pediatric cohort. We aimed to evaluate age- and sex-specific ranges for ISTH-BAT scores in individuals <18 years using an international dataset. Under the auspices of 2 ISTH Scientific Subcommittees, healthy participants <18 years were recruited from 7 countries across 5 continents. ISTH-BAT assessments were completed by trained investigators using a standard protocol. Participants were stratified by age quartile, sex, country, and World Bank income. Reference ranges were defined using the 2.5th to 97.5th percentile and assessed with 95% CIs. A total of 1168 participants were included (mean age ± SD, 7.7 ± 5.2 years; 50.5% female). The overall ISTH-BAT score reference range was 0 to 2. The overall distribution of scores across age quartiles was not statistically significantly different (P = .065). A significant positive trend in the proportion of participants with scores >0 was observed across increasing age quartiles (linear-by-linear association χ² = 47.3; P < .001). Females -more often than males- had a bleeding score > 0 (P = .02), with significant sex differences observed only in quartile 4 (P = .003). The 2.5th to 97.5th percentile for quartile 4 females was 0 to 3. Scores varied by country and income classification (P ≤ .001), but reference ranges remained stable. We conclude that the ISTH-BAT reference range of 0 to 2 is appropriate for individuals <18 years. For females (12-17 years), 0 to 3 may be considered and interpreted in conjunction with clinical context when guiding referral decisions.

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