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

J Am Acad Dermatol. 2017 Nov;77(5):868-873. doi: 10.1016/j.jaad.2017.06.003. Epub 2017 Aug 14.


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

Objective: 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.

Method: 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.

Results: 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.

Limitations: HSS scoring was not completely blinded.

Conclusion: 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.

Keywords: clinical practice; cutoff values; infantile hemangioma; propranolol; severity; treatment indication.

Publication types

  • Comparative Study

MeSH terms

  • Clinical Decision-Making*
  • Cohort Studies
  • Databases, Factual
  • Female
  • Follow-Up Studies
  • Hemangioma / drug therapy
  • Hemangioma / epidemiology
  • Hemangioma / pathology
  • Hemangioma, Capillary / drug therapy*
  • Hemangioma, Capillary / epidemiology
  • Hemangioma, Capillary / pathology*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Patient Selection
  • Propranolol / therapeutic use*
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index*
  • Skin Neoplasms / drug therapy*
  • Skin Neoplasms / epidemiology
  • Skin Neoplasms / pathology
  • Statistics, Nonparametric
  • Tertiary Care Centers
  • Treatment Outcome


  • Propranolol