Burn scar assessment: identification and testing of an objective multi-component device

[Truncated] Scarring is a consequence of burn injury healing and poses a substantial clinical problem. Poor scar outcomes are associated with a wide range of physical, psychological, and aesthetic problems for burn survivors. Currently, there is a lack of objective evidence-based scar assessment methods for clinical scar evaluation. Current scar assessment methods used clinically are subjective and most are low in reliability; objective scar assessment methods are also needed. Therefore this research project was undertaken with an overarching objective to identify and test an objective tool for scar assessment in clinical burns practice.

The work presented in this thesis was undertaken in three phases:

1. An extensive literature review of currently available scar assessment methods was undertaken and identified the DermaLab Combo® (Cortex Technologies, Denmark) multi-component device as an objective measure for testing in clinical burn scar assessment.

2. Three clinical studies (Studies I, II, III) were undertaken to support the testing of the DermaLab Combo® in burn scar assessment.

3. Evaluation of the results, discussion of scar assessment measurement issues and conclusions and recommendations for evidence-based scar assessment and future research.

Study I assessed the inter-rater reliability of the current scar assessment method used at Royal Perth Hospital (RPH), the modified Vancouver Scar Scale (mVSS), to enable its use as reference standard for subsequent testing of the DermaLab Combo®. Thirty subjects with burns scars were recruited and assessed by three raters using the mVSS. The ‘best’ and the ‘worst’ areas of the scar were assessed in comparison to the adjacent normal skin. The weighted kappa statistic (kw) and intra-class correlation coefficient (ICC) were used to measure inter-rater reliability. Inter-rater reliability of mVSS scores were found to be dependent on the severity of the scar, with higher reliability demonstrated for ‘worse’ scar areas. Inter-rater reliability also varied according to the individual scar parameters being measured; pliability demonstrated ‘excellent’ reliability, pigmentation ‘marginal to good’ reliability and both vascularity and height demonstrated ‘good to excellent’ reliability. The potential to misclassify some scar outcomes when using the mVSS was identified.