title: A prospective study of time to healing and hypertrophic scarring in paediatric burns: every day counts.
abstract: BACKGROUND
  It is commonly accepted that burns taking longer than 3 weeks to heal have a much higher rate of hypertrophic scarring than those which heal more quickly. However, some of our patients develop hypertrophic scars despite healing within this 3-week period.
  
  
  METHODS
  We performed a prospective study of 383 paediatric burns treated non-operatively at a regional burns centre over a 2-year period from May 2011 to April 2013. Scar assessment was performed by a senior burns therapist using the Vancouver Scar Scale.
  
  
  RESULTS
  Overall rates of hypertrophic scarring were 17.2%. Time to healing was the strongest predictor of developing hypertrophic scarring, and the earliest hypertrophic scar developed in a patient who was healed after 8 days. The risk of hypertrophic scarring was multiplied by 1.138 for every additional day taken for the burn wound to heal. There was a trend towards higher rates of hypertrophic scarring in non-white skin types but this did not reach statistical significance.
  
  
  CONCLUSIONS
  The risk of hypertrophic scarring increases with every day and, therefore, every effort should be made to get the wound healed as quickly as possible, even within the traditional 3-week period usually allowed for healing. We believe that the traditional dogma of aiming for healing within 3 weeks is overly simplistic and should be abandoned: in paediatric burns, every day counts.
  
  
  BACKGROUND
  Not applicable.
authors.affiliation: Burns Centre, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK.
authors.forename: Elizabeth
authors.identifier: 0000-0002-3930-7152
authors.initials: E
authors.lastname: Chipp
authors.affiliation: Burns Centre, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Charles
authors.affiliation: Burns Centre, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Burns Centre, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Whiting
authors.affiliation: Burns Centre, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK.
authors.forename: Naiem
authors.initials: N
authors.lastname: Moiemen
authors.affiliation: Burns Centre, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Wilson
keywords: Burn; Hypertrophic; Paediatric; Scar; Skin type; Time to healing