title: Reliable scar scoring system to assess photographs of burn patients.
abstract: BACKGROUND
  Several scar-scoring scales exist to clinically monitor burn scar development and maturation. Although scoring scars through direct clinical examination is ideal, scars must sometimes be scored from photographs. No scar scale currently exists for the latter purpose.
  
  
  METHODS
  We modified a previously described scar scale (Yeong et al., J Burn Care Rehabil 1997) and tested the reliability of this new scale in assessing burn scars from photographs. The new scale consisted of three parameters as follows: scar height, surface appearance, and color mismatch. Each parameter was assigned a score of 1 (best) to 4 (worst), generating a total score of 3-12. Five physicians with burns training scored 120 representative photographs using the original and modified scales. Reliability was analyzed using coefficient of agreement, Cronbach alpha, intraclass correlation coefficient, variance, and coefficient of variance. Analysis of variance was performed using the Kruskal-Wallis test. Color mismatch and scar height scores were validated by analyzing actual height and color differences.
  
  
  RESULTS
  The intraclass correlation coefficient, the coefficient of agreement, and Cronbach alpha were higher for the modified scale than those of the original scale. The original scale produced more variance than that in the modified scale. Subanalysis demonstrated that, for all categories, the modified scale had greater correlation and reliability than the original scale. The correlation between color mismatch scores and actual color differences was 0.84 and between scar height scores and actual height was 0.81.
  
  
  CONCLUSIONS
  The modified scar scale is a simple, reliable, and useful scale for evaluating photographs of burn patients.
authors.affiliation: Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Gabriel A
authors.initials: GA
authors.lastname: Mecott
authors.affiliation: Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas; Sealy Center for Molecular Medicine and the Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, Texas. Electronic address: ccfinner@utmb.edu.
authors.forename: Celeste C
authors.initials: CC
authors.lastname: Finnerty
authors.affiliation: Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
authors.affiliation: Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Al-Mousawi
authors.affiliation: Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Ludwik K
authors.initials: LK
authors.lastname: Branski
authors.affiliation: Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Sachin
authors.initials: S
authors.lastname: Hegde
authors.affiliation: Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Robert
authors.initials: R
authors.lastname: Kraft
authors.affiliation: Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Felicia N
authors.initials: FN
authors.lastname: Williams
authors.affiliation: Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Susana A
authors.initials: SA
authors.lastname: Maldonado
authors.affiliation: Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Haidy G
authors.initials: HG
authors.lastname: Rivero
authors.affiliation: Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Noe
authors.initials: N
authors.lastname: Rodriguez-Escobar
authors.affiliation: Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre and Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
mesh_terms: D002056:Burns / Q000473:pathology*; D002921:Cicatrix / Q000473:pathology*; D006801:Humans; D010781:Photography; D012107:Research Design; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology*
keywords: Burn; Hypertrophic scar; Photograph; Scale; Scar