Diagnosis and Management of Infantile Hemangioma

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Comparative Effectiveness Review Number 168 Diagnosis and Management of Infantile Hemangioma Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2010-0009-I Prepared by: Vanderbilt Evidence-based Practice Center Nashville, TN Investigators: Sivakumar Chinnadurai, M.D., M.P.H. Kristen Snyder, M.D. Nila Sathe, M.A., M.L.I.S. Chris Fonnesbeck, Ph.D. Anna Morad, M.D. Frances E. Likis, Dr.P.H., N.P., C.N.M. Tanya Surawicz, M.P.H. Genevieve Ness, Pharm.D. Cathy Ficzere, Pharm.D. Melissa L. McPheeters, Ph.D., M.P.H. AHRQ Publication No. 16-EHC002-EF January 2016
This report is based on research conducted by the Vanderbilt Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00009-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied. This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at www.effectivehealthcare.ahrq.gov. Search on the title of the report. Persons using assistive technology may not be able to fully access information in this report. For assistance contact EffectiveHealthCare@ahrq.hhs.gov. Suggested citation: Chinnadurai S, Snyder K, Sathe N, Fonnesbeck C, Morad A, Likis FE, Surawicz T, Ness G, Ficzere C, McPheeters ML. Diagnosis and Management of Infantile Hemangioma. Comparative Effectiveness Review No. 168. (Prepared by the Vanderbilt University Evidence-based Practice Center under Contract No. 290-2010-0009-I.) AHRQ Publication No.16-EHC002-EF. Rockville, MD: Agency for Healthcare Research and Quality; January 2016. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii
Page 1: Comparative Effectiveness Review Nu
Page 5 and 6: Acknowledgments The authors gratefu
Page 7 and 8: Peer Reviewers Prior to publication
Page 9 and 10: BCI; moderate SOE for effects of pr
Page 11 and 12: Overview of the Literature ........
Page 13 and 14: Executive Summary Introduction Infa
Page 15 and 16: for contextual questions as few eff
Page 17 and 18: Figure B. Analytic framework for KQ
Page 19 and 20: Table A. Inclusion criteria (contin
Page 21 and 22: precision (precise, imprecise), and
Page 23 and 24: Figure D. Estimates of expected IH
Page 25 and 26: majority of studies to date have in
Page 27 and 28: effectiveness outcomes. The evidenc
Page 29 and 30: changes. We considered the strength
Page 31 and 32: Table C. Summary of evidence in stu
Page 37 and 38: Table D. Summary of evidence in stu
Page 39 and 40: Applicability We set inclusion crit
Page 41 and 42: quantitative meta-analyses. Researc
Page 43 and 44: surgically. Lesion characteristics
Page 45 and 46: References 1. Wassef M, Blei F, Ada
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Page 49 and 50: modalities. The questions of imagin
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of data, and compiling evidence. We
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We only included studies published
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a standardized form (Appendix B) th
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Determining Quality Ratings • We
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Results We present results for Cont
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defects, urogenital anomalies, ulce
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Results of Literature Searches for
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Table 3. Characteristics of include
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scans, had a sensitivity of 20 perc
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of the model fit to all studies, bu
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Detailed Analysis Effectiveness of
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Table 6. Key resolution outcomes in
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with prednisolone included endocrin
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children in 8 studies), skin atroph
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hypopigmentation, impaired wound he
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fair quality for effectiveness outc
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studies of nadolol and atenolol. No
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Table 10. Key resolution outcomes i
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old. 100 Thirty percent of children
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Table 11. Resolution outcomes in st
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Table 15. Key outcomes in studies c
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Table 22. Harms/adverse effects in
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Table 24. Adverse effects in case s
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Table 24. Adverse effects in case s
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• In two RCTs reporting level of
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Nd:YAG Laser With Cooling Compared
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long term follow information was av
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Discussion State of the Literature
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Table 34. Strength of evidence for
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Effectiveness and Harms of Beta-Blo
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older children. One comparative stu
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case series reporting on rarer pres
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agents is critical, especially as u
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References 1. Wassef M, Blei F, Ada
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39. Chen TS, Eichenfield LF, Friedl
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80. Mai HM, Zheng JW, Wang YA, et a
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119. Sharma LK, Dalal SS. Corticost
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162. Snir M, Reich U, Siegel R, et
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198. Chen ZG, Zheng JW, Yuan ML, et
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237. Healy G, McGill T, Friedman EM
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Abbreviations and Acronyms Used in
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Appendix A. Search Strategies Searc
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Searches for Comparative Effectiven
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Appendix B. Screening and Quality A
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Harms Risk of Bias Assessment Form
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QUADAS Diagnostic Accuracy Rating T
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Infantile Hemangioma CER: Risk of B
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20. Grundfest-Broniatowski S, Carey
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65. Dachman AH, Lichtenstein JE, Fr
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111. Yoshida T, Kuratomi K, Mitsuma
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160. Newman SL, Goodwin CD. Colonic
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204. Crockett DM, Healy GB, McGill
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253. Wright GL, Smith RJ, Katz CD,
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301. Paley D, Jackson RW. Synovial
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346. Dombrowski MP, Budev H, Wolfe
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390. Stringel G. Giant hemangioma:
Page 201 and 202:
436. Liu HC, Chang MH, Lue HC, et a
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480. Casale AJ, Menashe DS. Massive
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526. Taylor RS, Joseph DB, Kohaut E
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571. Goldstein MH. The elastic flap
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614. Salloum E, Flamant F, Caillaud
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659. Fellows KE, Hoffer FA, Markowi
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706. Weatherford DA, Abrams RS, Wal
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749. Keleti D, Flickinger JC, Hobso
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793. Van Campenhout I, Patriquin H.
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836. Goldman MP, Fitzpatrick RE, Ru
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880. Schulman SR, Jones BR, Slotnic
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924. Egawa H, Berquist W, Garcia-Ke
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968. Thompson DN, Taylor WF, Haywar
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1013. Gregg CM, Wiatrak BJ, Koopman
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1056. Rozylo TK, Krupski W, Galkows
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1099. Fremont S, Kanny G, Bieber S,
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1142. Sreeram N, Miller P, John P.
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1185. Enjolras O, Wassef M, Mazoyer
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1228. Paley MR, Farrant P, Kane P,
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1271. Burrows PE, Robertson RL, Mul
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1312. Lezama-del Valle P, Gerald WL
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1352. Altunay IK, Gokdemir G, Koken
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1394. Kiristioglu I, Kilic N, Gurpi
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1480. Kreusel KM, Bechrakis NE, Hei
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1523. Wilken JJ, Meier FA, Kornstei
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1568. Garmendia G, Miranda N, Borro
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1610. Park EA, Seo JW, Lee SW, et a
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1652. Chatrath P, Black M, Jani P,
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1694. Hopf M, Hopf JUG, Rohde E, et
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1737. Rozylo-Kalinowska I, Brodzisz
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1782. Coras B, Hohenleutner U, Land
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1826. McQueen CT, Cullen RD. Endosc
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1866. Tsao MN, Schwartz ML, Bernste
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1909. Denier C, Labauge P, Brunerea
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1950. Mounayer C, Benndorf G, Bisdo
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1992. Woo SJ, Kim CJ, Yu YS. Cavern
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2036. Ersoy S, Mancini AJ. Hemifaci
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2077. Kronenberg A, Blei F, Ceisler
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2117. Sabharwal GK, Strouse PJ. Pos
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2159. Cannady SB, Kahn TA, Trabouls
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2200. Karikari IO, Selznick LA, Cum
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2241. Pienaar C, Graham R, Geldenhu
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2283. Wananukul S, Voramethkul W, N
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2327. Czernik A, Bystryn JC. Does i
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2368. Kamida T, Takeda Y, Fujiki M,
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2410. Rodgers B, Zeim S, Crawford B
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2453. Zolkipli Z, Aylett S, Rankin
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2495. Egberts F, Mentzel T, Leuschn
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2537. Kutluhan A, Bozdemir K, Ugras
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2580. Saetti R, Silvestrini M, Cutr
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2620. Yun TJ, Na DG, Kwon BJ, et al
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2661. Demirci H, Shields CL, Eagle
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2700. Iriz A, Durmaz E, Akmansu SH,
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2744. Ooi KG, Wenderoth JD, Francis
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2786. Tyzio R, Khalilov I, Represa
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2827. Bayliss SJ, Berk DR, Van Hare
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2869. Fernandez-Pineda I, Lopez-Gut
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2910. Kazim SF, Bhatti, Enam SA. In
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2953. Nonogaki S, Campos HGA, Butug
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2995. Storch CH, Hoeger PH. Propran
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3038. Al Dhaybi R, Superstein R, Mi
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3080. del Pozo J, Lopez-Gutierrez J
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3120. Guye E, Chollet-Rivier M, Sch
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3159. Kolokythas A, Al-Ghamian H, M
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3201. Nale P. Propranolol treatment
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3243. Soltani AM, Reinisch JF. Algo
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3286. . Derm Dx. Clinical Advisor.
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3326. Chang YT, Lin JY, Lee JY, et
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3367. Gross BC, Janus JR, Orvidas L
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3407. Kupeli S. Use of propranolol
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3448. Raches D, Hiscock M, Chapiesk
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3490. Traivaree C, Lumkul R, Torcha
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3532. Ammerman RT, Putnam FW, Altay
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3573. Chou S, Subramanian V, Lau HM
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3614. Hyland RM, Komlosi K, Alleman
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3655. Masetti R, Colecchia A, Ronde
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3693. Parikh SR, Darrow DH, Grimmer
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3732. Stiles JM, Amaya C, Rains S,
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3772. Zou HX, Jia J, Zhang WF, et a
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3813. Deng X, Wang K, Wu L, et al.
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3851. Khorsand K, Backus S, Sidbury
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3890. Phillips RJ, Lokmic Z, Crock
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3930. Weil AG, Bhatia S. Resection
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3969. Ravenscroft J. Management of
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where ΦΦ(xx) is the cumulative di
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Figure D-1. Estimates of expected I
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Figure D-3. Posterior SUCRA estimat
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Figure D-5. Network diagram of comp
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Appendix E. Study Design Classifica
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Author, Year Hogeling 2011 10 Alloc
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Author, Year Representativeness of
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Author, Year Were the harms predefi
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25. Qiu Y, Ma G, Yang J, et al. Imi
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56. Hassan BA, Shreef KS. Propranol
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88. Chakkittakandiyil A, Phillips R
Page 403 and 404:
120. Pandey A, Gangopadhyay AN, Gop
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Appendix G. Applicability Tables Ta
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Appendix H. Harms Reported in Packa
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o Acquired (autoimmune) hemolytic a
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o Ankylosing spondylitis o Dermatom
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H-7 • Increased dosage of rapidly
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Elocon® (mometason e furoate) 11 T
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Timoptic® (timolol maleate) 15 Tim
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Harms Data for Medications Included
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Table H-3: Adverse Events from Flo-
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(
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thromboembolism, thrombophlebitis,
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grades): 103 (48%), erosion/ulcerat
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acute myocardial infarction: 3 (Rat
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Discontinuations Patients utilizing
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ocular irritation including blephar
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Diagnosis and Management of Infantile Hemangioma

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