Colmenero-Sendra María, Del Boz-González Javier, Grau-Pérez Mercè, Ruiz-Villaverde Ricardo, Descalzo-Gallego Miguel Ángel, García-Doval Ignacio, Baselga Torres Eulalia
Dermatology Department, Hospital Costa del Sol, Marbella, Spain.
Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain.
JAMA Dermatol. 2025 Feb 1;161(2):203-207. doi: 10.1001/jamadermatol.2024.5125.
Although clinical practice guidelines exist for the treatment of infantile hemangiomas (IHs), recommendations are heterogeneous, and wide practice variations in IH management have been reported.
To analyze the degree of agreement in treatment choices for IH among pediatric dermatologists in North America and Europe and assess whether there are differences across IH risk categories.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional interrater and intrarater agreement study was conducted through a survey based on the Spanish Academy of Dermatology and Venereology IH prospective cohort. The survey used 50 vignettes of IH cases that were randomly selected from the cohort. It was administered twice in 2023, 1 month apart, to allow for interrater and intrarater agreement assessments. Data were analyzed in January 2024. The study involved pediatric dermatologists from North America (via the Pediatric Dermatology Research Alliance) and Europe (via the European Society of Pediatric Dermatologists).
Participants were asked to choose 1 of 3 treatment options (propranolol, topical timolol, or observation) for each vignette.
The primary outcome was the interrater agreement in treatment choices for IH cases, measured using κ statistics (Gwet AC1 coefficient).
The global interobserver agreement among 90 pediatric dermatologists was fair (AC1, 0.38; 95% CI, 0.29-0.46). In North America (45 pediatricians), agreement was moderate (AC1, 0.41; 95% CI, 0.33-0.49), while in Europe (45 pediatricians) it was fair (AC1, 0.37; 95% CI, 0.28-0.46). The degree of agreement varied depending on the risk category of IH, with excellent agreement in high-risk IH and only moderate agreement in intermediate-risk and low-risk IHs. Propranolol was predominantly chosen for high-risk IH, while observation was most frequent for low-risk IH (55.9%). The second survey had 61 respondents, with no significant intrarater differences.
The results of this survey study suggest that there is an important variability in the treatment of intermediate-risk and low-risk IH. The study findings support the need for more evidence regarding the role of topical timolol in IH treatment, which may help harmonize treatment approaches and improve consistency in IH management globally.
尽管存在关于婴儿血管瘤（IH）治疗的临床实践指南，但建议并不统一，并且已有报道称在IH管理方面存在广泛的实践差异。
分析北美和欧洲儿科皮肤科医生在IH治疗选择上的一致程度，并评估不同IH风险类别之间是否存在差异。
设计、背景和参与者：这项横断面的评分者间和评分者内一致性研究是基于西班牙皮肤病学和性病学学会的IH前瞻性队列进行的一项调查。该调查使用了从队列中随机选择的50个IH病例 vignettes。于2023年进行了两次，间隔1个月，以进行评分者间和评分者内一致性评估。2024年1月对数据进行了分析。该研究涉及来自北美的儿科皮肤科医生（通过儿科皮肤病学研究联盟）和欧洲的儿科皮肤科医生（通过欧洲儿科皮肤病学会）。
要求参与者为每个 vignette 从三种治疗选择（普萘洛尔、局部噻吗洛尔或观察）中选择一种。
主要结局是IH病例治疗选择的评分者间一致性，使用κ统计量（Gwet AC1系数）进行测量。
90名儿科皮肤科医生之间的总体观察者间一致性为中等（AC1，0.38；95%CI，0.29 - 0.46）。在北美（45名儿科医生），一致性为中等（AC1，0.41；95%CI，0.33 - 0.49），而在欧洲（45名儿科医生）为中等（AC1，0.37；95%CI，0.28 - 0.46）。一致程度因IH的风险类别而异，高风险IH的一致性极佳而中风险和低风险IH的一致性仅为中等。普萘洛尔主要用于高风险IH，而观察是低风险IH最常用的选择（55.9%）。第二次调查有61名受访者，评分者内无显著差异。
这项调查研究的结果表明，中风险和低风险IH的治疗存在重要差异。研究结果支持需要更多关于局部噻吗洛尔在IH治疗中作用的证据，这可能有助于协调治疗方法并提高全球IH管理的一致性。
