Pediatric, Khon Kaen University Faculty of Medicine, Khon Kaen, Thailand.
BMJ Paediatr Open. 2021 Sep 15;5(1):e001230. doi: 10.1136/bmjpo-2021-001230. eCollection 2021.
The general paediatricians and primary care physicians sometimes face immense difficulty in referral judgements regarding which infantile hemangiomas (IHs) require referrals and when is the appropriate time to refer IHs for treatment. This resulted in the treatment being delayed beyond IHs' critical timeframe. The Infantile Hemangioma Referral Score (IHReS) has been recently developed, with the aim to solve this problem.
The objective of the present study is to evaluate the reliability of IHReS and to assess the possibility of using this instrument in our country where a similar problem of delaying treatment of IHs is currently existing.
The present study was a prospective, cross-sectional study. Thirteen selected clinical cases were used to assess the reliability of IHReS among physicians who may have had the chance to deal with patients with IHs. The target physicians across the country were asked to participate in the study via an online platform (Google Forms) to decide whether to refer patients with IHs for treatment or observe. There were 3 steps of assessment: step 1, usual practice evaluation; step 2, using IHReS; step 3, retesting by using IHReS.
Substantial agreement was observed after using IHReS (step 2) for interrater reliability, with Fleiss' Kappa values of 0.80 and 0.78 among IH experts and non-expert physicians, respectively. Regarding repeatability, in the test-retest assessments, Cohen's Kappa coefficient values revealed almost perfect agreement in intrarater repeatability for both experts and non-expert physicians (1.00).
IHReS is a simple, easy-to-assess tool for non-expert physicians. The benefit in the increase of interrater agreement was found in both IH experts and non-expert physicians. It has had the reliability to be used in making referral decisions regarding patients with IH for treatment among Thai physicians. Using IHReS can improve clinical outcomes by identifying which patient needs early intervention to minimise the possible complications.
全科医生和初级保健医生有时在婴儿血管瘤（IH）的转诊判断方面面临巨大困难，即哪些 IH 需要转诊，何时是治疗的适当时间。这导致治疗延迟到 IH 的关键时间段之外。最近开发了婴儿血管瘤转诊评分（IHReS），旨在解决这个问题。
本研究的目的是评估 IHReS 的可靠性，并评估在我国使用该工具的可能性，因为我国目前存在 IH 治疗延迟的类似问题。
本研究为前瞻性横断面研究。使用 13 例选定的临床病例评估可能有机会处理 IH 患者的医生之间 IHReS 的可靠性。全国各地的目标医生被要求通过在线平台（Google 表单）参与研究，以决定是否将 IH 患者转诊进行治疗或观察。评估分为 3 个步骤：步骤 1，常规实践评估；步骤 2，使用 IHReS；步骤 3，使用 IHReS 重新测试。
使用 IHReS（步骤 2）进行评分者间可靠性后，观察到显著一致，IH 专家和非专家医生的 Fleiss' Kappa 值分别为 0.80 和 0.78。关于可重复性，在测试-再测试评估中，专家和非专家医生的 Cohen's Kappa 系数值均显示出几乎完全一致的内部评分者重复性（1.00）。
IHReS 是一种简单易用的非专家医生评估工具。在 IH 专家和非专家医生中，均发现评分者间一致性增加的益处。它具有在泰国医生中对 IH 患者进行治疗转诊决策的可靠性。使用 IHReS 可以通过识别需要早期干预以最小化可能并发症的患者来改善临床结局。
