Do clinicians estimates’ of scar thickness suffice for the assessment of scars?

Maria Shilova^1,2,2, Robert Ware⁴, Karin Plummer³, Roy Kimble^1,2, Bronwyn Griffin^1,3,4,
¹Queensland Children’s Hospital Queensland, Australia
²School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
³School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
⁴Menzies Health Institute Queensland, Griffith University Queensland, Australia
⁵Centre for Applied Economics, Griffith University, Brisbane, Queensland, Australia

Abstract

Introduction
Scar thickness is a parameter frequently used for the assessment of scars for both clinical and research purposes. However, literature demonstrates that it is often estimated by clinicians, rather than measured with the gold standard of ultrasound. This study aims to assess the equivalence of burns clinicians’ estimates and ultrasound measures of scar thickness in children.

Methods
This prospective cohort study involved children undergoing laser scar treatment under a general anaesthetic. Once participants were anaesthetised, the treating clinician selected points on the scar to be measured, based on heterogeneity of scar texture or colour. The scar thickness was measured with ultrasound, and then estimated by the treating clinician at the selected points. Ethics review and approval was obtained from the Queensland Children’s Hospital and Griffith University.

Results
Fifty children participated in the study and 172 scar points were measured. Clinician estimates were performed by doctors and a nurse practitioner. Using Bland Altman analysis to compare clinician estimates and ultrasound measurements, clinicians were found to under-estimate scar thickness by 0.19mm (bias) with limits of agreement at -2.3mm and +2.0mm (95%CI). Subgroup analyses are currently being undertaken.
Discussion
This study demonstrates that clinicians may under-estimate scar thickness by as much as 2.3mm, and over-estimate scar thickness by as much as 2mm, compared to ultrasound scar thickness measurement. This could result in important clinical repercussions, including the selection of different laser scar treatment settings.

Biography