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Journal of the American Academy of Dermatology
Volume 77, n° 5
pages 868-873 (novembre 2017)
Doi : 10.1016/j.jaad.2017.06.003
accepted : 2 June 2017
Original Articles

Use of the Hemangioma Severity Scale to facilitate treatment decisions for infantile hemangiomas

Andre Vadimovich Moyakine, MD , Bjorn Herwegen, BSc, Catharina Joanna Maria van der Vleuten, MD, PhD
 Department of Dermatology, Hecovan Expertise-Center for Hemangioma and Vascular Malformations, Radboud University Medical Center, Nijmegen, The Netherlands 

Reprint requests: Andre Vadimovich Moyakine, MD, Rene Descartesdreef 1, 6525 GL, Nijmegen, The Netherlands.Rene Descartesdreef 1, 6525 GLNijmegenThe Netherlands

The Hemangioma Severity Scale (HSS) assesses the severity of an infantile hemangioma (IH).


First, to compare HSS scores between patients with IH for whom propranolol treatment was indicated at their first visit and those who were not treated. Second, to assess suitable cutoff values for the need for propranolol treatment.


All patients with IH who attended our tertiary referral center since 2008 and were 0 to 6 months of age at their first visit were included. They were divided into propranolol and no-propranolol groups on the basis of choice of treatment at their first visit. HSS scores were assessed, and median scores were compared.


A total of 657 children (342 in the propranolol group) were included. The median HSS score (25th-75th percentile) in the propranolol group was 10 (range, 8-14) compared with 7 (range, 4-9) in the no-propranolol group (P  < .001). Cutoff values of 6 or lower (no indication for treatment) and 11 or higher (indication for treatment) resulted in 94% sensitivity and 89% specificity, respectively.


HSS scoring was not completely blinded.


The HSS with cutoff values of 6 or lower and 11 or higher could be used as a triage tool for propranolol treatment. Patient age, IH type, and parental preference may also contribute to treatment decisions.

The full text of this article is available in PDF format.

Key words : clinical practice, cutoff values, infantile hemangioma, propranolol, severity, treatment indication

Abbreviations used : AUC, HSS, IH

 Funding sources: None.
 Conflicts of interest: None declared.
 Dr Moyakine participated in generating, gathering, and interpreting the data for the study, and he wrote the majority of the original draft of the paper and approved the final version of this paper. Mr Herwegen participated in generating and gathering the data for the study and writing the paper, and he approved the final version of this paper. Dr van der Vleuten devised the design of the study and participated in generating and gathering the data for the study and writing the paper; she approved the final version of this paper and guarantees that all individuals who meet the authorship criteria of the Journal of the American Academy of Dermatology are included as authors of this paper.

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