Inter- and intra-observer variability in the selection of therapy for infantile hemangiomas among pediatric dermatologists in Spain.

Autor: Colmenero M; Dermatology Department, Hospital Costa del Sol, Marbella, Spain., Del Boz J; Dermatology Department, Hospital Universitario Regional, Málaga, Spain., Bernabeu Wittel J; Dermatology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain., Roé E; Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Feito-Rodríguez M; Dermatology Department, Hospital Universitario La Paz, Madrid, Spain., Vicente-Villa MA; Dermatology Department, Hospital Sant Joan de Deu, Barcelona, Spain., Martín-Santiago A; Dermatology Department, Hospital Son Espases, Mallorca, Spain., Palencia Pérez SI; Dermatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain., Azon A; Dermatology Department, Hospital Universitari Sant Joan de Reus, Reus, Spain., Valdivielso-Ramos M; Dermatology Department, Hospital Universitario Infanta Leonor, Madrid, Spain., Torrelo A; Dermatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain., Sánchez Moya AI; Dermatology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain., Campos-Domínguez M; Dermatology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain., Garnacho-Saucedo G; Dermatology Department, Hospital Universitario Reina Sofia, Córdoba, Spain., Azaña Defez JM; Dermatology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain., Vera Casaño Á; Dermatology Department, Hospital Universitario Regional, Málaga, Spain., Tercedor-Sánchez J; Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain., Alcalá R; Dermatology Department, Hospital de Sagunto, Valencia, Spain., González-Enseyat MA; Dermatology Department, Hospital Sant Joan de Deu, Barcelona, Spain., Giacaman A; Dermatology Department, Hospital Son Espases, Mallorca, Spain., Hernández-Martin Á; Dermatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain., Monserrat García MT; Dermatology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain., Bauzá A; Dermatology Department, Hospital Son Espases, Mallorca, Spain., Domínguez-Cruz J; Dermatology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain., García-Doval I; Research Unit, Fundación Piel Sana AEDV, Madrid, Spain., Grau-Pérez M; Research Unit, Fundación Piel Sana AEDV, Madrid, Spain.
Jazyk: angličtina
Zdroj: Pediatric dermatology [Pediatr Dermatol] 2022 Jul; Vol. 39 (4), pp. 557-562. Date of Electronic Publication: 2022 May 03.
DOI: 10.1111/pde.15015
Abstrakt: Background: Guidelines and expert recommendations on infantile hemangiomas (IH) are aimed at increasing homogeneity in clinical decisions based on the risk of sequelae.
Objective: The objective was to analyze the inter- and intra-observer agreement among pediatric dermatologists in the choice of treatment for IH.
Methods: 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 1 coefficient and Gwet's paired t test).
Results: 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 1  = 0.39, 95% confidence interval [CI]: 0.30-0.47). When stratified by risk category, good agreement was reached for high-risk hemangiomas (AC 1  = 0.77, 95% CI: 0.51-1.00), whereas for intermediate- and low-risk categories, the agreement was only fair (AC 1 0.31, 95% CI: 0.16-0.46 and AC 1  = 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.
(© 2022 Wiley Periodicals LLC.)
Databáze: MEDLINE
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