TABLE 7

Key Action Statement 1B: After identifying an IH as high risk, clinicians should facilitate an evaluation by a hemangioma specialist as soon as possible (grade X, strong recommendation).

Aggregate Evidence QualityGrade X
BenefitsPotential for early intervention for IH at a high risk of causing complications
Risks, harm, costPotential for delay in intervention if specialist evaluation cannot be arranged promptly or is unavailable in the geographic region; costs associated with specialist evaluation for IH incorrectly identified as high risk
Benefit-harm assessmentThe benefits of specialist evaluation outweigh harms and costs
Intentional vaguenessThe subcommittee recognizes the multidisciplinary nature of IH management and the diverse level of expertise among individuals in this field. As a result, the definition of a specialist with expertise in vascular birthmarks is vague. The subcommittee also recognizes that the time frame “as soon as possible” is vague.
Role of patient preferenceParental preference should be considered in the decision to see a specialist and in the choice of specialist
ExclusionsIHs not considered high risk
StrengthStrong recommendation
Key references1923