title: Patient-related keloid scar assessment and outcome measures.
abstract: BACKGROUND
  Keloid scars cause pain, itching, functional limitation, and disfigurement, leading to psychological distress. Progress in treatment regimens is hindered by the lack of a universally accepted outcome measure. The Patient and Observer Scar Assessment Scale is a tool for the assessment of scars, incorporating an assessment by both clinician and patient. This study evaluates its application to keloids and compares it to the widely used Vancouver Scar Scale, which is considered the standard mode of assessment for scars.
  
  
  METHODS
  Three observers using the two scales assessed 34 patients with 41 keloid scars independently. Patients evaluated their own scars simultaneously using the patient component of the Patient and Observer Scar Assessment Scale. Internal consistency, interobserver reliability, and convergent validity were examined.
  
  
  RESULTS
  Both components of the Patient and Observer Scar Assessment Scale had high internal consistency (0.82 and 0.86 for patient and observer components, respectively); those rates were higher than the rate for the Vancouver Scar Scale (0.65). Interobserver reliability was "substantial" for the Vancouver Scar Scale (0.65) and "almost perfect" for the observer component of the Patient and Observer Scar Assessment Scale (0.85). Convergent validity was very strong (0.83, p < 0.01), although the patient component did not correlate well with either of the observer scales. Patients rated their scars worse than the observer average for 83 percent of the scars, and were influenced by color, stiffness, thickness, and irregularity (p < 0.05).
  
  
  CONCLUSIONS
  The findings support the use of the Patient and Observer Scar Assessment Scale as a reliable and valid method of assessing keloid scars in a clinical context.
  
  
  METHODS
  Diagnostic, II.
authors.affiliation: London, United Kingdom From the Academic Burn and Microsurgery Group, Blizard Institute of Cell and Molecular Science.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Nicholas
authors.forename: Hannah
authors.initials: H
authors.lastname: Falvey
authors.forename: Pambos
authors.initials: P
authors.lastname: Lemonas
authors.forename: Gopinath
authors.initials: G
authors.lastname: Damodaran
authors.forename: Ali
authors.initials: A
authors.lastname: Ghannem
authors.forename: Florendyn
authors.initials: F
authors.lastname: Selim
authors.forename: Harshad
authors.initials: H
authors.lastname: Navsaria
authors.forename: Simon
authors.initials: S
authors.lastname: Myers
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D007627:Keloid / Q000473:pathology*; D008875:Middle Aged; D015588:Observer Variation; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D057566:Self Report; D011795:Surveys and Questionnaires; D055815:Young Adult