Burns Scar Index (Vancouver Scar Scale): Difference between revisions
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== Introduction == | == Introduction == | ||
Developed in 1990 by Sullivan et al<ref>Sullivan, T et al. [https://pubmed.ncbi.nlm.nih.gov/2373734/ Rating the burn scar]. The Journal of burn care & rehabilitation. 1990;11: 256-60. </ref>, the Vancouver Scar Scale (VSS) was the first widely used assessment to record [[Burns Overview|burns]] scars using a semi-quantitative approach<ref name=":1">Park JW, Koh YG, Shin SH, Choi Y, Kim W, Yoo HH, et al. [https://www.jkslms.or.kr/journal/view.html?uid=263&vmd=Full Review of Scar Assessment Scales.] Medical Lasers. 2022;11:1-7 </ref>, in order to measure change in scar appearance during healing and treatment<ref name=":0">Baryza, M J, and G A Baryza. [https://pubmed.ncbi.nlm.nih.gov/8537427/ The Vancouver Scar Scale: an administration tool and its interrater reliability.] The Journal of burn care & rehabilitation. 1995; 16: 535-8. </ref>. It is one of the most frequently used outcome measures for scar assessment<ref name=":1" />. | [[File:Hand burn.jpg|thumb|267x267px|Burn injury]] | ||
Developed in 1990 by Sullivan et al<ref>Sullivan, T et al. [https://pubmed.ncbi.nlm.nih.gov/2373734/ Rating the burn scar]. The Journal of burn care & rehabilitation. 1990;11: 256-60. </ref>, the Vancouver Scar Scale (VSS) was the first widely used assessment to record [[Burns Overview|burns]] scars using a semi-quantitative approach<ref name=":1">Park JW, Koh YG, Shin SH, Choi Y, Kim W, Yoo HH, et al. [https://www.jkslms.or.kr/journal/view.html?uid=263&vmd=Full Review of Scar Assessment Scales.] Medical Lasers. 2022;11:1-7 </ref>, in order to measure change in scar appearance during healing and [[Post-burn Rehabilitation|treatment]]<ref name=":0">Baryza, M J, and G A Baryza. [https://pubmed.ncbi.nlm.nih.gov/8537427/ The Vancouver Scar Scale: an administration tool and its interrater reliability.] The Journal of burn care & rehabilitation. 1995; 16: 535-8. </ref>. It is one of the most frequently used outcome measures for scar assessment<ref name=":1" />. | |||
The impacts of [[Scar Management|scarring]] can be multifaceted, including movement and function limitations, long term [[Pain Behaviours|pain]] or psycho-social effects, and therefore use of an outcome measure is beneficial to monitor the scars' progress<ref name=":3" />. | The impacts of [[Scar Management|scarring]] can be multifaceted, including movement and function limitations, long term [[Pain Behaviours|pain]] or psycho-social effects, and therefore use of an outcome measure is beneficial to monitor the scars' progress<ref name=":3" />. | ||
== Intended Population<br> == | == Intended Population<br> == | ||
The VSS is for use with patients with scarring from burn injuries<ref>Thompson CM, Sood RF, Honari S, Carrougher GJ, Gibran NS. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644737/#!po=83.3333 What score on the Vancouver Scar Scale constitutes a hypertrophic scar? Results from a survey of North American burn-care providers]. Burns. 2015; 41: 1442-1448</ref>. The VSS is used in both clinical practice and research<ref name=":0" />. | The VSS is for use with patients with scarring from burn injuries<ref>Thompson CM, Sood RF, Honari S, Carrougher GJ, Gibran NS. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644737/#!po=83.3333 What score on the Vancouver Scar Scale constitutes a hypertrophic scar? Results from a survey of North American burn-care providers]. Burns. 2015; 41: 1442-1448</ref>. The VSS is used in both clinical practice and [[research]]<ref name=":0" />. | ||
== Method of Use == | == Method of Use == | ||
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There is not strong evidence for the reliability of the VSS, with one systematic review describing the reliability as indeterminate<ref name=":2">Tyack Z., Simons M., Spinks A., Wasiak J. [https://pubmed.ncbi.nlm.nih.gov/22047828/ A systematic review of the quality of burn scar rating scales for clinical and research use]. Burns : journal of the International Society for Burn Injuries. 2012; 38: 6-18</ref>. Especially when the scar is larger in size or an asymmetrical shape<ref name=":1" />. Nonetheless, a more recent journal found "moderate" inter-rater reliability and "acceptable" internal consistency<ref name=":3">Min Hui Choo A., Siang Ong Y., Issa F. [https://www.frontiersin.org/articles/10.3389/fsurg.2021.643098/full Scar Assessment Tools: How Do They Compare?] Front. Surg. 2021</ref>. | There is not strong evidence for the reliability of the VSS, with one systematic review describing the reliability as indeterminate<ref name=":2">Tyack Z., Simons M., Spinks A., Wasiak J. [https://pubmed.ncbi.nlm.nih.gov/22047828/ A systematic review of the quality of burn scar rating scales for clinical and research use]. Burns : journal of the International Society for Burn Injuries. 2012; 38: 6-18</ref>. Especially when the scar is larger in size or an asymmetrical shape<ref name=":1" />. Nonetheless, a more recent journal found "moderate" inter-rater reliability and "acceptable" internal consistency<ref name=":3">Min Hui Choo A., Siang Ong Y., Issa F. [https://www.frontiersin.org/articles/10.3389/fsurg.2021.643098/full Scar Assessment Tools: How Do They Compare?] Front. Surg. 2021</ref>. | ||
Research suggests different modifications to improve the reliability, including to improve the instructions and teaching<ref>da Costa PTL., Echevarría-Guanilo ME., Gonçalves N., Girondi JBR, Gonçalves ADC. [https://pubmed.ncbi.nlm.nih.gov/33979826/ Subjective Tools for Burn Scar Assessment: An Integrative Review]. Advances in skin & wound care 2021; 34: 1-10</ref>, or the use of a pocket tool | Research suggests different modifications to improve the reliability, including to improve the clarity of the instructions and increase teaching of how to apply the VSS<ref>da Costa PTL., Echevarría-Guanilo ME., Gonçalves N., Girondi JBR, Gonçalves ADC. [https://pubmed.ncbi.nlm.nih.gov/33979826/ Subjective Tools for Burn Scar Assessment: An Integrative Review]. Advances in skin & wound care 2021; 34: 1-10</ref>, or the use of a pocket tool<ref name=":0" />. | ||
=== Validity === | === Validity === | ||
The VSS is described as one of the first validated scar assessment tools<ref name=":4">Carrière M.E., Van de Kar A.L., Van Zuijlen, P.P.M. Scar Assessment Scales. In: Téot L., Mustoe T.A., Middelkoop E., Gauglitz G.G. (eds) Textbook on Scar Management. Springer, Cham. 2020</ref>. However, more recent systematic reviews do not support this claim<ref name=":2" /><ref>Brusselaers N., Pirayesh A., Hoeksema H., Verbelen J., Blot S., Monstrey S. [https://pubmed.ncbi.nlm.nih.gov/20828761/ Burn scar assessment: a systematic review of different scar scale]s. The Journal of surgical research. 2010; 164: 115-23</ref>. But, because the VSS is often modified, in multiple different ways including changing the | The VSS is described as one of the first validated scar assessment tools<ref name=":4">Carrière M.E., Van de Kar A.L., Van Zuijlen, P.P.M. Scar Assessment Scales. In: Téot L., Mustoe T.A., Middelkoop E., Gauglitz G.G. (eds) Textbook on Scar Management. Springer, Cham. 2020</ref>. However, more recent systematic reviews do not support this claim<ref name=":2" /><ref>Brusselaers N., Pirayesh A., Hoeksema H., Verbelen J., Blot S., Monstrey S. [https://pubmed.ncbi.nlm.nih.gov/20828761/ Burn scar assessment: a systematic review of different scar scale]s. The Journal of surgical research. 2010; 164: 115-23</ref>. But, because the VSS is often modified, in multiple different ways including changing the existing items or adding extra ones<ref name=":4" />, it is difficult to accurately assess the validity on a large scale<ref name=":3" />. Moreover, within the research the majority of subjects were adult Caucasian males, limiting the validity to this population<ref name=":5">Tyack Z, Wasiak J, Spinks A, Kimble R, Simons M. [https://pubmed.ncbi.nlm.nih.gov/23768711/ A guide to choosing a burn scar rating scale for clinical or research use.] Burns : journal of the International Society for Burn Injuries. 2013; 39: 1341-50</ref>. | ||
=== Responsiveness === | === Responsiveness === | ||
Among all burn scar scales, there is only preliminary evidence supporting their accuracy in measuring changes to the scar over time<ref name=":5" />. | Among all burn scar scales, there is only preliminary evidence supporting their accuracy in measuring changes to the scar over time<ref name=":5" />. | ||
The VSS does not measure patients own subjective assessment of the scar, such as pain or itching, or impact on their day to day life<ref name=":1" />. It is anticipated also incorporating these factors into an outcome measure would improve patient centered care and satisfaction<ref>Lipman K., Wang M., Berthiaume E., Holloway J., Da Lio A, Ting K., et al. [https://pubmed.ncbi.nlm.nih.gov/31688125/ Evaluating Current Scar Assessment Methods]. Annals of plastic surgery. 2020; 84: 222-231 | The VSS does not measure patients own subjective assessment of the scar, such as pain or itching, or the impact on their day to day life<ref name=":1" />. It is anticipated also incorporating these factors into an outcome measure would improve patient centered care and satisfaction<ref>Lipman K., Wang M., Berthiaume E., Holloway J., Da Lio A, Ting K., et al. [https://pubmed.ncbi.nlm.nih.gov/31688125/ Evaluating Current Scar Assessment Methods]. Annals of plastic surgery. 2020; 84: 222-231 | ||
</ref>. | </ref>. | ||
=== | === References === | ||
= | |||
<references /> | <references /> | ||
[[Category:Burns]] | |||
[[Category:Outcome Measures]] | |||
[[Category:Assessment]] |
Revision as of 09:43, 23 May 2022
Original Editor - User:Chloe Waller
Top Contributors - Chloe Waller, Kim Jackson and Vidya Acharya
Introduction[edit | edit source]
Developed in 1990 by Sullivan et al[1], the Vancouver Scar Scale (VSS) was the first widely used assessment to record burns scars using a semi-quantitative approach[2], in order to measure change in scar appearance during healing and treatment[3]. It is one of the most frequently used outcome measures for scar assessment[2].
The impacts of scarring can be multifaceted, including movement and function limitations, long term pain or psycho-social effects, and therefore use of an outcome measure is beneficial to monitor the scars' progress[4].
Intended Population
[edit | edit source]
The VSS is for use with patients with scarring from burn injuries[5]. The VSS is used in both clinical practice and research[3].
Method of Use[edit | edit source]
Four characteristics of the scar are assessed. These are: vascularity, height, pliability, and pigmentation[6]. Each characteristic is given a score, which are added together to give an overall score between 0 and 13[7].
Evidence[edit | edit source]
Reliability[edit | edit source]
There is not strong evidence for the reliability of the VSS, with one systematic review describing the reliability as indeterminate[8]. Especially when the scar is larger in size or an asymmetrical shape[2]. Nonetheless, a more recent journal found "moderate" inter-rater reliability and "acceptable" internal consistency[4].
Research suggests different modifications to improve the reliability, including to improve the clarity of the instructions and increase teaching of how to apply the VSS[9], or the use of a pocket tool[3].
Validity[edit | edit source]
The VSS is described as one of the first validated scar assessment tools[10]. However, more recent systematic reviews do not support this claim[8][11]. But, because the VSS is often modified, in multiple different ways including changing the existing items or adding extra ones[10], it is difficult to accurately assess the validity on a large scale[4]. Moreover, within the research the majority of subjects were adult Caucasian males, limiting the validity to this population[12].
Responsiveness[edit | edit source]
Among all burn scar scales, there is only preliminary evidence supporting their accuracy in measuring changes to the scar over time[12].
The VSS does not measure patients own subjective assessment of the scar, such as pain or itching, or the impact on their day to day life[2]. It is anticipated also incorporating these factors into an outcome measure would improve patient centered care and satisfaction[13].
References[edit | edit source]
- ↑ Sullivan, T et al. Rating the burn scar. The Journal of burn care & rehabilitation. 1990;11: 256-60.
- ↑ 2.0 2.1 2.2 2.3 Park JW, Koh YG, Shin SH, Choi Y, Kim W, Yoo HH, et al. Review of Scar Assessment Scales. Medical Lasers. 2022;11:1-7
- ↑ 3.0 3.1 3.2 Baryza, M J, and G A Baryza. The Vancouver Scar Scale: an administration tool and its interrater reliability. The Journal of burn care & rehabilitation. 1995; 16: 535-8.
- ↑ 4.0 4.1 4.2 Min Hui Choo A., Siang Ong Y., Issa F. Scar Assessment Tools: How Do They Compare? Front. Surg. 2021
- ↑ Thompson CM, Sood RF, Honari S, Carrougher GJ, Gibran NS. What score on the Vancouver Scar Scale constitutes a hypertrophic scar? Results from a survey of North American burn-care providers. Burns. 2015; 41: 1442-1448
- ↑ Fearmonti R., Bond J., Erdmann D., & Levinson H. A review of scar scales and scar measuring devices. Eplasty. 2010: 10; 43
- ↑ Nguyen T, Feldstein S, Shumaker P, Krakowski A. A review of scar assessment scales. Seminars in Cutaneous Medicine and Surgery. 2015; 34.
- ↑ 8.0 8.1 Tyack Z., Simons M., Spinks A., Wasiak J. A systematic review of the quality of burn scar rating scales for clinical and research use. Burns : journal of the International Society for Burn Injuries. 2012; 38: 6-18
- ↑ da Costa PTL., Echevarría-Guanilo ME., Gonçalves N., Girondi JBR, Gonçalves ADC. Subjective Tools for Burn Scar Assessment: An Integrative Review. Advances in skin & wound care 2021; 34: 1-10
- ↑ 10.0 10.1 Carrière M.E., Van de Kar A.L., Van Zuijlen, P.P.M. Scar Assessment Scales. In: Téot L., Mustoe T.A., Middelkoop E., Gauglitz G.G. (eds) Textbook on Scar Management. Springer, Cham. 2020
- ↑ Brusselaers N., Pirayesh A., Hoeksema H., Verbelen J., Blot S., Monstrey S. Burn scar assessment: a systematic review of different scar scales. The Journal of surgical research. 2010; 164: 115-23
- ↑ 12.0 12.1 Tyack Z, Wasiak J, Spinks A, Kimble R, Simons M. A guide to choosing a burn scar rating scale for clinical or research use. Burns : journal of the International Society for Burn Injuries. 2013; 39: 1341-50
- ↑ Lipman K., Wang M., Berthiaume E., Holloway J., Da Lio A, Ting K., et al. Evaluating Current Scar Assessment Methods. Annals of plastic surgery. 2020; 84: 222-231