title: What score on the Vancouver Scar Scale constitutes a hypertrophic scar? Results from a survey of North American burn-care providers.
abstract: BACKGROUND
  Reliable characterization of a hypertrophic scar (HTS) is integral to epidemiologic studies designed to identify clinical and genetic risk factors for HTS. The Vancouver Scar Scale (VSS) has been widely used for this purpose; however, no publication has defined what score on this scale corresponds to a clinical diagnosis of HTS.
  
  
  METHODS
  In a survey of 1000 burn care providers, we asked respondents what VSS score indicates a HTS and asked them to score scar photos using the VSS. We used receiver-operating-characteristic (ROC) curves to evaluate VSS sub-scores and their combinations in diagnosis of HTS.
  
  
  RESULTS
  Of 130 responses (13.5%), most were physicians (43.9%) who had worked in burn care for over 10 years (63.1%) and did not use the VSS in clinical practice (58.5%). There was no consensus as to what VSS score indicates a diagnosis of HTS. VSS height score (0-3) performed best for diagnosis of HTS; using a cut-off of ≥1, height score was 99.5% sensitive and 85.9% specific for HTS.
  
  
  CONCLUSIONS
  Burn clinicians do not routinely use the VSS and perceptions vary widely regarding what constitutes a HTS. When a dichotomous variable is needed, the VSS height score with a cut-off of ≥1 may be optimal. Our findings underscore the need for an objective tool to reproducibly characterize HTS across burn centers.
authors.affiliation: Department of Surgery, UW Medicine Regional Burn Center, Harborview Medical Center, Seattle, WA, United States. Electronic address: calliemt@uw.edu.
authors.forename: Callie M
authors.initials: CM
authors.lastname: Thompson
authors.affiliation: Department of Surgery, UW Medicine Regional Burn Center, Harborview Medical Center, Seattle, WA, United States.
authors.forename: Ravi F
authors.initials: RF
authors.lastname: Sood
authors.affiliation: Department of Surgery, UW Medicine Regional Burn Center, Harborview Medical Center, Seattle, WA, United States.
authors.forename: Shari
authors.initials: S
authors.lastname: Honari
authors.affiliation: Department of Surgery, UW Medicine Regional Burn Center, Harborview Medical Center, Seattle, WA, United States.
authors.forename: Gretchen J
authors.initials: GJ
authors.lastname: Carrougher
authors.affiliation: Department of Surgery, UW Medicine Regional Burn Center, Harborview Medical Center, Seattle, WA, United States.
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Gibran
mesh_terms: D002053:Burn Units / Q000706:statistics & numerical data; D002056:Burns / Q000150:complications*; D017439:Cicatrix, Hypertrophic / Q000145:classification* / Q000209:etiology / Q000473:pathology; D006801:Humans; D015601:Injury Severity Score; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014481:United States
keywords: Burn; Hypertrophic scar; Vancouver Scar Scale