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" />.   
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" />.   
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 [[Scar Management|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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=== Reliability  ===
=== Reliability  ===
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>. 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 improves the inter-rater reliability to good<ref name=":0" />.
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 improves the inter-rater reliability to good<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 its validity<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 4 items or adding ones<ref name=":4" />, it is difficult to accurately assess the validity<ref name=":3" />. Moreover, within the research the majority of subjects were adult Caucasian males, limiting the validity to this population<ref>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>.
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 4 items or adding 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" />.
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


=== Miscellaneous<span style="font-size: 20px; font-weight: normal;" class="Apple-style-span"></span><br> ===
</ref>.


== Links ==
=== Links ===


== References  ==
== References  ==


<references />
<references />

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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 instructions and teaching[9], or the use of a pocket tool improves the inter-rater reliability to good[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 4 items or adding 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 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].

Links[edit | edit source]

References[edit | edit source]

  1. ↑ Sullivan, T et al. Rating the burn scar. The Journal of burn care & rehabilitation. 1990;11: 256-60.
  2. ↑ 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. ↑ 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. ↑ 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
  5. ↑ 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
  6. ↑ Fearmonti R., Bond J., Erdmann D., & Levinson H. A review of scar scales and scar measuring devices. Eplasty. 2010: 10; 43
  7. ↑ Nguyen T, Feldstein S, Shumaker P, Krakowski A. A review of scar assessment scales. Seminars in Cutaneous Medicine and Surgery. 2015; 34.
  8. ↑ 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
  9. ↑ 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. ↑ 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
  11. ↑ 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. ↑ 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
  13. ↑ 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
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