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Feb 2012

Measuring the Severity of Infantile Hemangiomas: Instrument Development and Reliability

Author Affiliations

Author Affiliations: Departments of Dermatology and Pediatrics (Dr Haggstrom) and Public Health and Pediatrics (Dr Swigonski), Indiana University School of Medicine, Indianapolis; Departments of Medical Social Sciences (Ms Beaumont and Drs Lai and Cella) and Pediatrics and Dermatology (Drs Mancini and Chamlin), Northwestern University Feinberg School of Medicine, Chicago, Illinois; Divisions of Hematology/Oncology (Dr Adams) and Pediatric Dermatology (Dr Lucky), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Dermatology, Medical College of Wisconsin, Milwaukee (Drs Drolet, Holland, and Siegel); Departments of Dermatology and Pediatrics, University of California, San Francisco School of Medicine, San Francisco (Dr Frieden); Department of Dermatology, Columbia University, New York, New York (Drs Garzon and Morel); Section of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, Missouri (Drs Horii, Newell, and Nopper); and Department of Dermatology, Baylor College of Medicine, Houston, Texas (Dr Metry).

Arch Dermatol. 2012;148(2):197-202. doi:10.1001/archdermatol.2011.926

Objectives To develop instruments that measure the severity of infantile hemangiomas (Hemangioma Severity Scale [HSS]) and the complications of infantile hemangiomas for longitudinal use (Hemangioma Dynamic Complication Scale [HDCS]).

Design Instrument development and reliability study.

Setting Academic research.

Participants The HSS and the HDCS were developed through the collaborative effort of members of the Hemangioma Investigator Group Research Core, an expert multi-institutional research group. After development of the scales, 13 pediatric dermatologists used the HSS to score 20 different hemangiomas. In addition, 12 pediatric dermatologists used the HDCS to score hemangioma-related complications for 24 clinical scenarios. Interrater and intrarater reliability was measured for both scales.

Main Outcome Measures Interrater and intrarater reliability.

Results For the HSS, interrater reliability and intrarater reliability exceeded 99%. Similarly, the HDCS had a high rate of interrater agreement; for individual items, agreement among raters was 67% to 100%, with most clinical scenarios demonstrating greater than 90% agreement. Intrarater reliability was excellent for all individual items of the HDCS.

Conclusion The HSS and the HDCS are reliable scales that can be used to measure the severity of infantile hemangiomas, including the severity of complications for longitudinal use.