12 para hemangiomas

The Infantile Hemangioma Referral Score

TAKE-HOME MESSAGE

• The authors developed a two-part algorithm for primary care physicians (PCPs) when determining whether to monitor or refer a patient with an infantile hemangioma to a dermatologist. The Infantile Hemangioma Referral Score (IHReS) includes 12 questions and is designed to alert PCPs to high-risk hemangiomas that warrant immediate referral as well as aid in monitoring lesions that are not considered high risk.

• An expert panel evaluated 42 infantile hemangioma test cases to determine if referral or monitoring was appropriate, and this was considered the gold standard. When 45 PCPs used the IHReS to score these test cases, the tool had a sensitivity of 96.9% and specificity of 55%. Of note, while some PCPs erred by choosing to refer rather than monitor, when using the IHReS tool, no PCP chose to monitor a lesion that should have been referred to an expert.

– Caitlyn T. Reed, MD

Abstract

OBJECTIVES

Infantile hemangiomas (IHs) are common; some cases require timely referral and treatment to prevent complications. We developed and validated a reliable instrument for timely and adequate referral of patients with IH to experts by nonexpert primary physicians.

METHODS

In this multicenter, cross-sectional, observational study, we used a 3-stage process: (1) development of the Infantile Hemangioma Referral Score (IHReS) tool by IH experts who selected a representative set of 42 IH cases comprising images and a short clinical history, (2) definition of the gold standard for the 42 cases by a second independent committee of IH experts, and (3) IHReS validation by nonexpert primary physicians using the 42 gold standard cases.

RESULTS

A total of 60 primary physicians from 7 different countries evaluated the 42 gold standard cases (without reference to the IHReS tool); 45 primary physicians evaluated these cases using the IHReS questionnaire, and 44 completed retesting using the instrument. IHReS had a sensitivity of 96.9% (95% confidence interval 96.1%-97.8%) and a specificity of 55.0% (95% confidence interval 51.0%-59.0%). The positive predictive value and negative predictive value were 40.5% and 98.3%, respectively. Validation by experts and primary physicians revealed substantial agreement for interrater reliability and intrarater repeatability.

CONCLUSIONS

IHReS, a 2-part algorithm with a total of 12 questions, is an easy-to-use tool for primary physicians for the purpose of facilitating correct and timely referral of patients with IH. IHReS may help practitioners in their decision to refer patients to expert centers.

Pediatrics

The Infantile Hemangioma Referral Score: A Validated Tool for Physicians

Pediatrics 2020 Apr 01;145(4)e20191628, C Léauté-Labrèze, E Baselga Torres, L Weibel, LM Boon, M El Hachem, C van der Vleuten, J Roessler, A Troilius Rubin

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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