title: Patient reported facial scar assessment: directions for the professional.
abstract: BACKGROUND
  The face is central to our identity and provides our most expressive means of communication. Currently, the role of facial scarring in relation to self-esteem is unclear and the value of self-reported scar assessment is insufficiently understood. The aim of this study was twofold: (1) to assess the extent of agreement between patients' ratings and observers' ratings of facial scar characteristics; and (2) to examine if patients' and observers' scar characteristics ratings, or the differences, are associated with the patients' self-esteem.
  
  
  METHODS
  A prospective study was conducted including patients with facial burns. Patients completed the Patient and Observer Scar Assessment Scale (POSAS) and the Rosenberg Self-Esteem Scale 3 months post-burn.
  
  
  RESULTS
  Ninety-four subjects were included, 76 (81%) men and mean percentage TBSA burned was 12.4 (SD 10.4; range 1-50). Subject's and observer's assessment were significantly positively correlated and were identical in 53% of the cases. Subjects' assessments and discrepancy scores on the scar characteristic surface roughness were associated with self-esteem in multiple regression analysis.
  
  
  CONCLUSIONS
  The majority of the patients scored the quality of facial scars in a similar way as the professionals. Furthermore, facial scarring appeared only moderately associated with self-esteem. However, our study suggests that using both patients' and professionals' scar assessments provides more useful information regarding the patients' well-being relative to focussing on the separate assessments only. In particular a discrepancy between the patients' and professionals' view on surface roughness might be an early indication of psychological difficulties and a call for further clinical attention.
authors.affiliation: Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: hoogewerfc@maasstadziekenhuis.nl.
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: Hoogewerf
authors.affiliation: Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Margriet E
authors.initials: ME
authors.lastname: van Baar
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands; Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Middelkoop
authors.affiliation: Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: van Loey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002056:Burns / Q000523:psychology / Q000628:therapy*; D002921:Cicatrix / Q000523:psychology*; D005145:Face; D005151:Facial Injuries / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D012649:Self Concept; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: Burn; Head; POSAS; Scald; Scar assessment; Scar characteristic; Self-esteem