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The Chip Score: A Method to Determine Risk of Surgical Intervention for Hemangioma Patients

Wee, Corinne MD; Grunzweig, Katherine Alan MD; Ezaldein, Harib MD; Coquillard, Cristin MD; Kumar, Anand R. MD, FACS, FAAP

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 54
doi: 10.1097/01.GOX.0000584512.72422.5d
Craniofacial Abstracts

Case Western Reserve University, Cleveland, OH

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

BACKGROUND: Infantile hemangiomas (IHs) are the most common benign tumor of infancy and can have profound effects on the well-being of patients.1 With the variability in the use of surgery among 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 IHs at a single tertiary care center over 17 years. Patients were divided equally into 2 groups. Descriptive statistics and correlation plots were performed on the first cohort to evaluate which disease factors (such as size, location, and 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 with length of medical management as a covariate against the second cohort of patients.

RESULTS: After controlling for length of medical management, lack 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 3 (of a maximum score of 3) was found to have a specificity of 92% and a sensitivity of 81% in predicting risk of surgical intervention.

CONCLUSIONS: IHs 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.


1. Krowchuk DP, Frieden IJ, Mancini AJ, et al; Subcommittee on the Management of Infantile Hemangiomas. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019;143:e20183475.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.