Longitudinal monitoring and prediction of long-term outcome of scar stiffness on pediatric patients.

Bettina Müller,Julia Elrod,Clemens Schiestl,Edoardo Mazza

doi:10.1093/burnst/tkab028

Bettina Müller, Julia Elrod + Show 2 more

Open Access

https://doi.org/10.1093/burnst/tkab028

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Journal: Burns & trauma	Publication Date: Jan 1, 2021
Citations: 3	License type: CC BY 4.0

Affiliation: ETH Zurich, University Children's Hospital Zurich

Abstract

BackgroundHypertrophic scarring after burn injury is one of the greatest unmet challenges in patients with burn injuries. A better understanding of the characteristics of scar maturation and early prediction of the long-term outcome of scarring are prerequisites for improving targeted therapies and pivotal for patient counselling.MethodsRepeated measurements of scar stiffness in 11 pediatric patients were performed over the course of 1 year using 2 suction devices, the Cutometer and the Nimble. In addition, the observer pliability score of the Patient and Observer Scar Assessment Scale was applied. This longitudinal study allowed quantification of the ability of each of the measured parameters to reflect scar maturation, as indicated by change in skin pliability/stiffness, over time (using linear regression); the ability to distinguish individual patients (intraclass correlation coefficient (ICC)); the correlation of the devices (Spearman correlation coefficient); and the ability to predict long-term scar maturation based on early scar assessment (using receiver operating characteristic).ResultsAll the tools used showed significant longitudinal decrease of scar stiffness from 3 months until 12 months after the injury. The Nimble (ICCpatientNimble = 0.99) and the Cutometer (ICCpatientCuto = 0.97) demonstrated an excellent ability to distinguish between individual patients. The Nimble seemed to be able to predict the 12-month pliability of scars based on early (3-month) measurements (area under the curve (AUC)12mPOSAS = 0.67; AUC12mC = 0.46; AUC12mN = 0.79).ConclusionsThe results of this preliminary study suggest that all 3 tools provide suitable means to quantify alterations in scar stiffness over time. Initial evidence suggests the Nimble is most favorable for predicting changes in stiffness associated with long-term scar maturation. Further studies with a larger sample size are required to validate tissue suction as a clinical tool for analysis of changes of scar stiffness over time.

Highlights

Hypertrophic scarring after burn injury is one of the greatest unmet challenges in patients with burn injuries
The observer pliability score of the Patient and Observer Scar Assessment Scale was applied. This longitudinal study allowed quantification of the ability of each of the measured parameters to reflect scar maturation, as indicated by change in skin pliability/stiffness, over time; the ability to distinguish individual patients (intraclass correlation coefficient (ICC)); the correlation of the devices (Spearman correlation coefficient); and the ability to predict longterm scar maturation based on early scar assessment
Our results indicate that the Nimble and the Cutometer and the Patient and Observer Scar Assessment Scale (POSAS) observer pliability score could provide suitable outcome measures for the monitoring of scar maturation in terms of alterations of scar stiffness and pliability, respectively

Summary

Introduction

Hypertrophic scarring after burn injury is one of the greatest unmet challenges in patients with burn injuries. The observer pliability score of the Patient and Observer Scar Assessment Scale was applied This longitudinal study allowed quantification of the ability of each of the measured parameters to reflect scar maturation, as indicated by change in skin pliability/stiffness, over time (using linear regression); the ability to distinguish individual patients (intraclass correlation coefficient (ICC)); the correlation of the devices (Spearman correlation coefficient); and the ability to predict longterm scar maturation based on early scar assessment (using receiver operating characteristic). A significant percentage of burns in pediatric patients result in hypertrophic scarring that may entail substantial functional disability and esthetic impairment, depending on the depth, extent and anatomical location of the burn [1, 2]. Wound infection and prolonged healing negatively affect scar outcome [12,13,14]

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