Burns Scar Index (Vancouver Scar Scale)

Original Editor - User:Chloe Waller

Top Contributors - Chloe Waller, Kim Jackson and Vidya Acharya  

Introduction[edit | edit source]

Burn injury

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]

  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