Subjective Tools for Burn Scar Assessment: An Integrative Review

Abstract

OBJECTIVE To review the clinical and scientific literature on the subjective ways of assessing burn scars and describe their main characteristics. DATA SOURCES The Latin American, Caribbean Health Sciences Literature, Nursing Database, PubMed, CINAHL, and Scopus and Web of Science databases were used to search for studies published between 2014 and 2018 using descriptors in Portuguese, Spanish, and English. STUDY SELECTION After establishing the research question and the location and definition of the studies, as well as accounting for differences among databases and application of filters based on inclusion and exclusion criteria, 886 references remained. DATA EXTRACTION Investigators reviewed the titles and abstracts of the sample and selected 188 relevant studies for full review. DATA SYNTHESIS Twenty-six subjective forms of assessment were found; most research concerned the Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale. CONCLUSIONS The Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale are the most common scales for assessing burn scars and have similar evaluation points such as vascularization, pliability, pigmentation, and height, which are the main parameters that contribute to the general assessment and severity of a scar. There is a need to improve instructions for application of the scales to facilitate better understanding and improve agreement among evaluators.

A Comprehensive Review of Evaluating Donor Site Morbidity and Scar Outcomes in Skin Transfer Techniques

“…Scar assessment methodologies: Several subjective scar assessment scales have been developed to qualitatively measure scar appearance, offering both patient and observer perspectives. Examples include the Vancouver Scar Scale (VSS) and the POSAS [ 30 , 31 ]. These tools provide valuable insights into the qualitative aspects of scars, enabling a more comprehensive evaluation of their appearance.…”

“…Despite the development of various quantitative tools, their clinical relevance and feasibility vary, and consensus on the most appropriate evaluation method is lacking [ 32 ]. The VSS, POSAS, and Visual Analog Scale (VAS) stand out as widely utilized scar assessment tools, with the VSS evaluating vascularity, pigmentation, pliability, and height, and the POSAS incorporating subjective symptoms and basic scar evaluation [ 30 ]. A notable gap in scar assessment lies in the need for improved instructions to enhance the standardization of these scales.…”

The Measure of a Scar: Patient Perceptions and Scar Optimization after Skin Cancer Reconstruction

“…The observer then rates the scar based on a Likert rating categorizing vascularity (pale/pink/red/purple/mix), pigmentation (hypo-/hyper-/ mix), thickness (thicker/thinner), relief (surface irregularities; more/less/mix), pliability (supple/stiff/mix), and surface area (expansion/contraction/mix). 14 As this scale incorporates both patient input and physician or observer assessment, it has become a widely accepted outcome instrument to measure scar attributes with a high quality rating in total score reliability. 3 In the field of facial plastic surgery, POSAS has high interobserver reliability for skin graft measurement after Mohs micrographic surgery 13 and facial scar.…”

In vivo burn scar assessment with speckle decorrelation and joint spectral and time domain optical coherence tomography

“…3 Accurate assessment and measurement of scar severity is vital for monitoring the healing process and providing guidance on the appropriate treatment to improve the quality of life of patients. 4 Currently several scar assessment methods are used, including the Vancouver Scar Scale (VSS), which quantifies vascularity, pliability, and height of a scar, and the Patient and Observer Scar Assessment Scale which assesses observer and patient opinions on different scar characteristics. 5,6 These scales take into account factors, including height, pigmentation, thickness, pliability, and overall appearance of the scar.…”

“…Scarring can have multiple long-term impacts, including pruritus, pain, and restricted movement 3 . Accurate assessment and measurement of scar severity is vital for monitoring the healing process and providing guidance on the appropriate treatment to improve the quality of life of patients 4 …”