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.
Abstract
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 0 was observed across increasing age quartiles (linear-by-linear association χ² = 47.3; P 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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