Abstract
Healing after dermal injury is a complex but imperfect process that results in a wide range of visible scars. The degree of disfigurement is not the sole determinant of a scar's effect on patient well-being, with a number of other factors being critical to outcome. These include cosmetic appearance, symptoms such as itch and pain, functional loss, psychological or social problems, and quality of life. An accurate assessment of these domains can help clinicians measure outcomes, develop, and evaluate treatment strategies. A PubMed literature search was performed up to 31st March 2020. Ten objective scar measurements, four Clinician-Reported Outcome Measures (CROMs), six Patient-Reported Outcome Measures (PROMs), and one combined measure were evaluated for their reliability, clinical relevance, responsiveness to clinical change, and feasibility. Many quantitative tools were limited in their clinical relevance and feasibility, whereas few qualitative CROMs and PROMs have undergone rigorous assessment. This review examines currently available assessment tools, focusing primarily on subjective scar measurements (CROMs, PROMs), and offers a perspective on future directions in the field.
Highlights
What Is a Scar?A scar is the macroscopic disturbance of the normal structure and function of skin, formed following the maturation phase of wound healing [1, 2]
- Responsive: If clinicians are to use the tool to assess patients’ scars over time or after treatment, the tool should be able to detect these changes. This can be represented by the Tstatistic, effect size (ES), Guyatt’s responsiveness statistic (GRS), or standardised response mean (SRM)
The Manchester Scar Scale (MSS) is a multi-item categorical scale, with a global scar assessment made with a visual analogue scale (VAS) [8]
Summary
A scar is the macroscopic disturbance of the normal structure and function of skin, formed following the maturation phase of wound healing [1, 2]. While these measurements might be seen as an objective and quantifiable way to assess scars, none of the available tools combine clinical relevance and feasibility. - Reliable: For the tool to be used in large and multiple studies, the same scar should obtain the same results between different raters (inter-rater reliability) or subsequent evaluations by the same rater (intra-rater reliability). - Responsive: If clinicians are to use the tool to assess patients’ scars over time or after treatment, the tool should be able to detect these changes. This can be represented by the Tstatistic, effect size (ES), Guyatt’s responsiveness statistic (GRS), or standardised response mean (SRM). - Feasible: The target audience (including patients, clinicians, and researchers) should be able to use the tool efficiently and cost-effectively, and interpret the results
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