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The CHIP Score: A Valuable Tool to Evaluate Risk of Surgical Intervention in Hemangioma Patients
Corinne Wee, MD; Katherine Grunzweig, MD; Harib Ezaldein, MD; Anand Kumar, MD
Case Western Reserve University
2019-02-05
Presenter: Corinne Wee
Affidavit:
I certify that this project represents the original work of the resident submitting the work.
Director Name: Anand Kumar MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND: Infantile hemangiomas (IHs) are the most common benign tumor of infancy and can have profound effects on the well-being of patients. With the variability in use of surgery amongst providers, it can be difficult to counsel patients and their families on potential surgical treatment. Through the development of the Case Western Hemangioma Intervention Predictor (CHIP) score, this study aims to improve the consistency of counseling regarding surgery and timing of surgical referral.
METHODS: This was a retrospective review of all patients (181) treated for infantile hemangiomas at a single tertiary care center over 17 years. Patients were divided equally into two groups. Descriptive statistics and correlation plots were performed on the first cohort to evaluate which disease factors (such as size, location, complications) and patient factors significantly correlated to surgical risk. These factors were used to form a CHIP score, which was then validated through logistic regression against the second cohort of patients.
RESULTS: Lack of medical management, length of medical management, functional impairment and ulceration were found to be significantly associated with surgical risk (p<0.05). When validated against the second half of our cohort, a CHIP score of 4 (of a maximum score of 4) was found to have a specificity of 89% and a sensitivity of 87% in predicting risk of surgical intervention.
CONCLUSIONS: Infantile hemangiomas can have clinical characteristics that may be predictors of complexity and surgical intervention. The CHIP score can assist in educating patients on surgery as a treatment option and guiding appropriate referrals.
