Identification of factors predicting scar outcome after burn injury in children: a prospective case-control study

Abstract

BackgroundThere is a lack of rigorous research investigating the factors that influence scar outcome in children. Improved clinical decision-making to reduce the health burden due to post-burn scarring in children will be guided by evidence on risk factors and risk stratification. This study aimed to examine the association between selected patient, injury and clinical factors and the development of raised scar after burn injury. Novel patient factors were investigated including selected immunological co-morbidities (asthma, eczema and diabetes type 1 and type 2) and skin pigmentation (Fitzpatrick skin type).MethodsA prospective case-control study was conducted among 186 children who sustained a burn injury in Western Australia. Logistic regression was used to explore the relationship between explanatory variables and a defined outcome measure: scar height measured by a modified Vancouver Scar Scale (mVSS).ResultsThe overall correct prediction rate of the model was 80.6%; 80.9% for children with raised scars (>1 mm) and 80.4% for children without raised scars (≤1 mm). After adjustment for other variables, each 1% increase in % total body surface area (%TBSA) of burn increased the odds of raised scar by 15.8% (95% CI = 4.4–28.5%). Raised scar was also predicted by time to healing of longer than 14 days (OR = 11.621; 95% CI = 3.727–36.234) and multiple surgical procedures (OR = 11.521; 1.994–66.566).ConclusionsGreater burn surface area, time to healing of longer than 14 days, and multiple operations are independently associated with raised scar in children after burn injury. Scar prevention strategies should be targeted to children with these risk factors.

Studying the healing and long-term outcomes of two partial thickness wound models using different wound dressings

“…Longer healing times were associated with higher POSAS and VSS scar scores and higher incidences of hypertrophic scarring in burns [51-53, 55, 57, 129, 131-133]. Also, the model confirmed that a larger TBSA % and deeper burns had a negative effect on scarring, as had also been reported before [51,53,55]. Interestingly, infection seemed to be related to both higher scar scores and incidences of HTS at six months' follow up.…”

“…Factors thought to cause severe or pathological scarring include: healing time extending beyond 14 [51] or 21 days [52], deeper wounds, larger extent of the burn [53], wound infection [54], female sex, young age [55], dark skin type (nonwhite) [56], skin grafting [55], burn on trunk or upper limb [57] and high BMI (for which there is weak evidence) [58].…”

“…When examining predictive factors for scar outcome in the children (Study V) we used the highest total scores reported with POSAS and VSS. When a child had more than one scar, we chose the one with the highest score (worse scarring), a strategy which has been used in a similar study [51].…”

Randomized clinical trial of negative pressure wound therapy as an adjunctive treatment for small-area thermal burns in children

“…As with previous paediatric burn studies 45 , the trial recorded low rates of long-term follow-up: only 15 per cent of participants attended both appointments. It also bears emphasis that the study predominantly involved superficial partial-thickness burns with a TBSA of under 2 per cent, which are not in the highest risk category for hypertrophic scarring 6 . Additional studies are needed to determine whether the beneficial effects of NPWT might translate to a more meaningful impact on scarring in children with larger, deeper burns.…”

Ultrasonographic findings of re-epithelialized skin after partial-thickness burns

“…In human burns, delayed wound healing is a significant risk factor for hypertrophic scarring [ 1 ], and healing time is an important factor in the prediction of scarring and the selection of scar prevention methods [ 2 , 3 ]. Because of the strong relationship between the proportion of LEB thickness and healing time, we hypothesize that the proportion of LEB thickness is also a useful prognostic factor in the prediction of scarring.…”