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Background: CAPTsure (Clinical Assessment of PTS) is a new tool for diagnosis and severity rating of pediatric postthrombotic syndrome (PTS). Our objective was to test the reliability, measurement error, and minimal detectable change of CAPTSure., Methods: Children aged newborn to 18 years who sustained upper extremity or lower extremity deep vein thrombosis (DVT) were enrolled ≥ 6 months after DVT diagnosis. Patients were assessed by 2 raters to determine the reliability of the clinician assessment component (CC) of CAPTSure. Patients/proxies completed CAPTSure at baseline and approximately 2 weeks later to assess test-retest reliability of the symptoms component (SC)., Results: Of 148 patients enrolled in the study; 30 had sustained either bilateral or both upper and lower extremity DVT. Hence, 178 extremities were assessed for PTS signs (86 upper extremity, 92 lower extremity). Intraclass correlation coefficient (ICC) for the CC was 0.89 (95% confidence interval [CI], 0.84-0.93) for upper extremity and 0.88 (95% CI, 0.83-0.92) for lower extremity. Nonclinicians performed 59% of measurements. Ninety-eight patients completed the SC at baseline and follow-up, for a total of 60 upper extremity and 61 lower extremity assessments. ICC for the SC was 0.89 (95% CI, 0.84-0.93) for upper extremity and 0.92 (0.87-0.95) for lower extremity. ICC for CAPTSure was 0.92 (95% CI, 0.87-0.95) for upper extremity and 0.93 (95% CI, 0.88-0.95) for lower extremity assessment. Measurement error ranged between 1.7 and 4.3 of 100 points. A change of approximately 11 of 100 points in CAPTSure score would be required to be confident that there was a change in PTS severity., Conclusion: CAPTSure has excellent reliability and a small measurement error, even when applied by nonhematologists., Competing Interests: 5LRB, MLA, SW, EP, JV, CL, and MIM report nothing to disclose. BMF is a DSMB member for Pfizer, BMS, Novartis, Optum, and Abbvie outside the submitted work; these companies had no involvement with study design, conduction, analysis, or reporting. During the conduction of the study, LA received support from a Canadian Institutes of Health Research Post‐doctoral Fellowship., (© 2019 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals, Inc on behalf of International Society on Thrombosis and Haemostasis.)

Objective: The aim of this study was to introduce the VaccinaTion & Hpv Knowledge (THinK) questionnaire to assess knowledge about human papillomavirus (HPV) and attitude to HPV-vaccination. Its reliability and validity was demonstrated in a sample of women living in Sicily (southern Italy)., Methods: A cross-sectional survey was conducted on a sample of 220 women at the "Paolo Giaccone" University Hospital in Palermo (Sicily), aged 18-61. Data were analyzed through Cronbach's alpha and exploratory factor analysis, followed by a structural equation model with measurement component. The two-level data structure was explicitly considered., Results: Three dimensions were found: "knowledge of HPV infection (kHPV), "Attitude to be vaccinated against HPV (aHPV)" and "Knowledge about vaccines (KV)" (97% overall explained variance). Internal consistency was good for the whole questionnaire (0.82) and the first dimension (0.88) and acceptable for the second (0.78) and the third dimension (0.73). 23% of women showed no or little knowledge of HPV and 44.3% of women had no or little knowledge about HPV induced lesions., Discussion: The use of a validated questionnaire may serve as a useful measure to assess general knowledge about HPV and attitude towards vaccination against HPV in the primary prevention setting., Competing Interests: The authors declare there are no competing interests.

Background: Pediatric tools for diagnosis of post-thrombotic syndrome (PTS) include the assessment of limb edema as a symptom (patient/proxy-reported) and as a sign. However, it is unclear whether these two approaches refer to the same clinical aspect of PTS. This could result in overestimation of disease severity. We sought to evaluate the correlation among different techniques to assess limb edema as a sign and as a symptom in children who sustained upper extremity (UE) or lower extremity (LE) deep vein thrombosis (DVT) and were, therefore, at risk of PTS., Methods: Limb edema was cross-sectionally measured as a symptom (ie, patient- or proxy-reported) and as a sign (ie, clinician-assessed limb circumference difference, limb volume ratio, bioimpedance spectroscopy ratio (BIS), and durometry ratio) in 140 children at risk of PTS (n = 70 UE-DVT, n = 70 LE-DVT). Item-item correlations were estimated using Pearson or Spearman correlation coefficients, as appropriate, and separately for the UE and LE groups., Results: In the UE-DVT group, proxy-reported swelling correlated weakly to moderately with circumference difference and with volume ratio, but not with BIS ratio. In the LE-DVT group, proxy-reported swelling correlated moderately with thigh circumference difference and volume ratio, and patient-reported swelling correlated moderately with BIS ratio., Conclusion: Our findings suggest that patient/proxy-reported and clinician-assessed limb edema measure slightly different aspects of PTS, justifying their inclusion in pediatric PTS tools. In addition, proxy-reported swelling was in closer agreement with clinician-assessed total limb size (ie, observed edema), and patient-reported swelling in the LE seemed to reflect limb fluid content (ie, perceived edema).

Background: Symptoms and function in pediatric post-thrombotic syndrome (PTS) remain poorly characterized., Methods: The present cross-sectional study describes the characteristics of pain, other symptoms, and impaired function in pediatric PTS in a cohort of children with history of upper or lower limb deep vein thrombosis and PTS diagnosis. The frequency of clinical findings was compared between patients with and without pain, and between patients with upper and lower extremity PTS., Results: Seventy-eight children were included in the study. The most common PTS symptoms were pain, tired limb and heaviness. Symptoms were usually reported to occur at mid-day or later and were typically triggered by exercise. Half the patients reported impaired endurance. Pain was reported by 45% of patients and was usually mild-moderate. Heaviness, tightness, tired limb, paresthesia, self-reported limb edema, and impaired endurance were most common in patients with than in patients without pain. Conversely, activity and participation scores, skin redness, and clinician-assessed limb edema did not differ between patients with and without pain. Lastly, there was no difference in pain intensity or frequency of paresthesia, swelling, heaviness, or impaired endurance when comparing the upper and lower extremities., Conclusion: Tired limb, heaviness, pain, and impaired endurance were the most frequent clinical findings in pediatric PTS. Frequency of symptoms and pain intensity did not differ between upper and lower extremities. Pain was associated with the presence of other symptoms and impaired function, but not with activity limitation and participation restriction. Better tools are needed to measure these two latter aspects of health.