Ms Rhianydd Thomas^1,2, Ms Stephanie  Wicks¹, Mrs Claire Toose¹, Dr Marita  Dale³, Dr Verity Pacey²

¹Children’s Hospital At Westmead, Sydney, Australia, ²Macquarie University, Sydney, Australia, ³University of Sydney, Sydney, Australia

Abstract:

Aim

Identification of children at risk of palmar burn scar is important for early initiation of scar management. This study determined inter-rater reliability of face-to-face and photographic assessments of 29 palmar cutaneous functional units (CFUs), predicted to scar following palmar burn. The validity of photographic compared to face-to-face assessment, and the predictive validity of both assessment types to identify scarring at 3-6 months following burn, were also established.

Methods

Thirty-nine children (40 hands) post palmar burn were assessed face-to-face following wound healing, by three physiotherapists. Photographs of the children’s hands, taken at this assessment, were assessed by the same physiotherapists a minimum of six months later. To determine which CFUs scarred, children were reassessed at 3-6 months post burn. For analysis, 29 CFUs were merged into eight separate groups to determine the number of CFUs predicted to scar per CFU group for both assessment types.

Results

Excellent inter-rater reliability was established for face-to-face assessment in all eight CFU groups (ICC2,1 0.83-0.96). Photographic assessment demonstrated good to excellent inter-rater reliability in six CFU groups (ICC2,1 0.69-0.90) and validity in seven CFU groups (ICC2,1 0.66-0.87). Good to excellent predictive validity was established in seven CFU groups for face-to-face (ICC2,1 0.60-0.95) and photographic assessments (ICC2,1 0.69-0.89).

Conclusion

Experienced therapists can reliably assess CFUs face-to-face or via photographs and predict future scar development. Prediction of palmar scarring from a photograph may be useful for determining scar management need when children are unable to attend face-to-face assessment. This may support future growth of telehealth.

Biography:

Rhi is a physiotherapist who works in the Burns Unit at The Children’s Hospital at Westmead. She completed a Master of Research in 2018 and commenced a PhD in 2019 focusing on the role of early and intensive splinting to prevent contracture following palm burns in young children