How to assess scar quality in pediatric burn patients: a systematic review on the type and content of outcome measurement instruments.

Abstract

Measuring scar quality is important for monitoring scar development and evaluating treatment outcomes. Given the substantial representation of children within the burn population and their susceptibility to lifelong scarring, evaluating scar quality is particularly important in this group. This study provides an overview of outcome measurement instruments used to assess scar quality in pediatric burn patients. A systematic literature search was conducted in PubMed, EMBASE and Web of Science covering studies published up to March 25, 2024. We included original research studies in English that measured at least one scar quality characteristic in pediatric burn patients. We included 328 studies and identified 585 outcome measurement instruments: clinician-reported outcome measures (CROMs) (53%), measurement devices (25%), and patient-reported outcome measures (PROMs) (22%). The most frequently used instruments were the (modified) Vancouver Scar Scale (m)(VSS), ultrasound, and the Patient and Observer Scar Assessment Scale (POSAS) Patient scale, respectively. Thickness and itch were the most frequently assessed scar characteristics. The use of PROMs has increased over the past decade, particularly after 2016, highlighting their growing attention. Among the studies using PROMs, 42% reported age-related conditions, with thresholds for independent completion ranging from 5 to 16 years. However, CROMs are the most frequently used instruments. While PROMs, CROMs and measurement devices are valuable, they are often not specifically designed for or validated in pediatric burn patients, and therefore they could benefit from further development or validation to better address the specific needs of pediatric burn patients.