Dermatology Department, Hospital Costa del Sol, Marbella, Spain.
Dermatology Department, Hospital Universitario Regional, Málaga, Spain.
Pediatr Dermatol. 2022 Jul;39(4):557-562. doi: 10.1111/pde.15015. Epub 2022 May 3.
Guidelines and expert recommendations on infantile hemangiomas (IH) are aimed at increasing homogeneity in clinical decisions based on the risk of sequelae.
The objective was to analyze the inter- and intra-observer agreement among pediatric dermatologists in the choice of treatment for IH.
We performed a cross-sectional inter-rater and intra-rater agreement study within the Spanish infantile hemangioma registry. Twenty-seven pediatric dermatologists were invited to participate in a survey with 50 clinical vignettes randomly selected within the registry. Each vignette contained a picture of an infantile hemangioma with a clinical description. Raters chose therapy among observation, topical timolol, or oral propranolol. The same survey reordered was completed 1 month later to assess intra-rater agreement. Vignettes were stratified into hemangioma risk categories following the Spanish consensus on IH. The agreement was measured using kappa statistics appropriate for the type of data (Gwet's AC coefficient and Gwet's paired t test).
Twenty-four dermatologists completed the survey. Vignettes represented 7.8% of the Spanish hemangioma registry. The inter-rater agreement on the treatment decision was fair (AC = 0.39, 95% confidence interval [CI]: 0.30-0.47). When stratified by risk category, good agreement was reached for high-risk hemangiomas (AC = 0.77, 95% CI: 0.51-1.00), whereas for intermediate- and low-risk categories, the agreement was only fair (AC 0.31, 95% CI: 0.16-0.46 and AC = 0.38, 95% CI: 0.27-0.48, respectively). Propranolol was the main option for high-risk hemangiomas (86.4%), timolol for intermediate-risk (36.8%), and observation for low-risk ones (55.9%). The intra-rater agreement was good. The inter-rater agreement between pediatric dermatologists on the treatment of IH is only fair. Variability was most significant with intermediate- and low-risk hemangiomas.
婴幼儿血管瘤（IH）的指南和专家建议旨在提高基于后遗症风险的临床决策的同质性。
分析儿科皮肤科医生在选择 IH 治疗方案时的组间和组内一致性。
我们在西班牙婴幼儿血管瘤登记处进行了一项跨评价者和组内评价者的一致性研究。邀请了 27 名儿科皮肤科医生参与一项调查，该调查使用了随机从登记处中选择的 50 个临床病例。每个病例都包含一个婴儿血管瘤的图片和临床描述。评估者选择观察、局部噻吗洛尔或口服普萘洛尔进行治疗。1 个月后，同样的调查重新完成以评估组内一致性。病例按照西班牙 IH 共识进行风险分层。使用适合数据类型的kappa 统计量（Gwet 的 AC 系数和 Gwet 的配对 t 检验）来衡量一致性。
24 名皮肤科医生完成了调查。病例代表了西班牙血管瘤登记处的 7.8%。治疗决策的组间一致性为中等（AC=0.39，95%置信区间[CI]：0.30-0.47）。按风险类别分层时，高风险血管瘤的一致性较好（AC=0.77，95%CI：0.51-1.00），而中低风险类别的一致性仅为中等（AC 0.31，95%CI：0.16-0.46 和 AC=0.38，95%CI：0.27-0.48）。普萘洛尔是高风险血管瘤的主要选择（86.4%），噻吗洛尔是中风险的（36.8%），观察是低风险的（55.9%）。组内一致性较好。儿科皮肤科医生在 IH 治疗方面的组间一致性仅为中等。中低风险血管瘤的变异性最大。
