Infantile hemangiomas (IH) guidelines and expert recommendations strive to increase uniformity in clinical decisions based on the risk of sequelae. The study aimed to analyze inter- and intra-observer agreement among pediatric dermatologists on the selection of IH therapy.
Within the Spanish infantile hemangioma registry, researchers conducted cross-sectional inter-rater and intra-rater agreement research. Fifty clinical vignettes from the registry were randomly chosen, and 27 pediatric dermatologists were asked to take part in the survey. Each vignette featured a clinical description and a photograph of an infantile hemangioma. The raters selected therapies were observation, topical timolol, and oral propranolol. To evaluate intra-rater agreement, the same survey that had been reordered was finished after a month. Following the Spanish agreement on IH, vignettes were divided into hemangioma risk groups. The kappa statistics is relevant to the type of data (Gwet’s AC1 coefficient and Gwet’s paired t-test) were used to assess the degree of agreement.
The survey was completed by 24 dermatologists. 7.8% of the Spanish registry of hemangiomas were vignettes. (AC1 = 0.39, 95% CI: 0.30-0.47) The inter-rater agreement on the treatment decision was fair. When risk groups were stratified, high-risk hemangiomas had strong agreement (AC1 = 0.77, 95% CI: 0.51-1.00), but intermediate- and low-risk categories had only fair agreement (AC1 0.31, 95% CI: 0.16-0.46 and AC1 = 0.38, 95% CI: 0.27-0.48, respectively). For high-risk hemangiomas, propranolol was the preferred treatment (86.4%), timolol for intermediate-risk hemangiomas (36.8%), and observation for low-risk hemangiomas (55.9%). Good inter-rater reliability was observed.
Only fair inter-rater agreements existed between pediatric dermatologists for the management of IH. The variability was greatest in low- and intermediate-risk hemangiomas.