title: Accuracy of remote burn scar evaluation via live video-conferencing technology.
abstract: Telemedicine in outpatient burn care, particularly in burn scar management, may provide cost-effective care and comes highly rated by patients. However, an effective scar scale using both video and photographic elements has not been validated. The purpose of this study is to test the reliability of the Patient and Observer Scar Assessment Scale (POSAS) using live video-conferencing.
  
  
  
  A prospective study was conducted with individuals with healed burn scars in Kathmandu, Nepal. Three independent observers assessed 85 burn scars from 17 subjects, using the Observer portion to evaluate vascularity, pigmentation, thickness, relief, pliability, surface area, and overall opinion. The on-site observer was physically present with the subjects and used a live videoconferencing application to show the scars to two remote observers in the United States. Subjects used the Patient portion to evaluate the scar that they believed appeared the worst appearance and had the greatest impact on function.
  
  
  
  The single-rater reliability of the Observer scale was acceptable (ICC>0.70) in overall opinion, thickness, pliability, and surface area. The average-rater reliability for three observers was acceptable (ICC>0.70) for all parameters except for vascularity. When comparing Patients' and Observers' overall opinion scores, patients consistently reported worse opinion.
  
  
  
  Evaluation of burn scars using the Patient and Observer Scar Assessment Scale can be accurately performed via live videoconferencing and presents an opportunity to expand access to burn care to rural communities, particularly in low- and middle-income countries, where patients face significant access barriers to appropriate follow-up care.
authors.affiliation: Stanford School of Medicine, Stanford University, United States. Electronic address: lcai1214@stanford.edu.
authors.forename: Lawrence Z
authors.initials: LZ
authors.lastname: Cai
authors.affiliation: University of Washington Regional Burn Center, United States.
authors.forename: Maria
authors.initials: M
authors.lastname: Caceres
authors.affiliation: Department of Physical Therapy, Kirtipur Hospital, Nepal; ReSurge International, California, United States.
authors.forename: Mohan Krishna
authors.initials: MK
authors.lastname: Dangol
authors.affiliation: Division of Plastic Surgery, Kirtipur Hospital, Nepal; ReSurge International, California, United States.
authors.forename: Kiran
authors.initials: K
authors.lastname: Nakarmi
authors.affiliation: Division of Plastic Surgery, Kirtipur Hospital, Nepal; ReSurge International, California, United States.
authors.forename: Shankar Man
authors.initials: SM
authors.lastname: Rai
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Stanford University, United States; ReSurge International, California, United States.
authors.forename: James
authors.initials: J
authors.lastname: Chang
authors.affiliation: University of Washington Regional Burn Center, United States.
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Gibran
authors.affiliation: University of Washington Regional Burn Center, United States.
authors.forename: Tam N
authors.initials: TN
authors.lastname: Pham
mesh_terms: D006801:Humans; D002921:Cicatrix / Q000473:pathology; D015203:Reproducibility of Results; D011446:Prospective Studies; D002056:Burns / Q000150:complications / Q000628:therapy; D010361:Patients
keywords: Agreement; Hypertrophic scar; POSAS; Reliable; Telemedicine