title: Ultrasound is a reproducible and valid tool for measuring scar height in children with burn scars: A cross-sectional study of the psychometric properties and utility of the ultrasound and 3D camera.
abstract: OBJECTIVE
  The aim of this study was to investigate the reproducibility and validity of measuring scar height in children using ultrasound and 3D camera.
  
  
  METHODS
  Using a cross-sectional design, children with discrete burn scars were included. Reproducibility was tested using Intraclass Correlation Coefficient (ICC) for reliability, and percentage agreement within 1mm between test and re-test, standard error of measurement (SEM), smallest detectable change (SDC) and Bland Altman limits of agreement for agreement. Concurrent validity was tested using Spearman's rho for support of pre-specified hypotheses.
  
  
  RESULTS
  Forty-nine participants (55 scars) were included. For ultrasound, test-retest and inter-rater reproducibility of scar thickness was acceptable for scarred skin (ICC=0.95, SDC=0.06cm and ICC=0.82, SDC=0.14cm). The ultrasound picked up changes of <1mm. Inter-rater reproducibility of maximal scar height using the 3D camera was acceptable (ICC=0.73, SDC=0.55cm). Construct validity of the ultrasound was supported with a strong correlation between the measure of scar thickness and observer ratings of thickness using the POSAS (ρ=0.61). Construct validity of the 3D camera was also supported with a moderate correlation (ρ=0.37) with the same measure using maximal scar height.
  
  
  CONCLUSIONS
  The ultrasound is capable of detecting smaller changes or differences in scar thickness than the 3D camera, in children with burn scars. However agreement as part of reproducibility was lower than expected between raters for the ultrasound. Improving the accuracy of scar relocation may go some way to address agreement.
authors.affiliation: Department of Occupational Therapy, Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, Queensland 4101, Australia; Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland 4101, Australia. Electronic address: Megan.Simons@health.qld.gov.au.
authors.forename: M
authors.initials: M
authors.lastname: Simons
authors.affiliation: Department of Occupational Therapy, Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, Queensland 4101, Australia; Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland 4101, Australia. Electronic address: Emma.GeeKee@health.qld.gov.au.
authors.forename: E Gee
authors.initials: EG
authors.lastname: Kee
authors.affiliation: Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland 4101, Australia; Department of Paediatric Surgery, Urology, Neonatal Surgery, Burns and Trauma, Lady Cilento Children's Hospital, Brisbane, Queensland 4101, Australia; School of Medicine, The University of Queensland, St Lucia, Queensland 4067, Australia. Electronic address: royk@uq.edu.au.
authors.forename: R
authors.initials: R
authors.lastname: Kimble
authors.affiliation: Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland 4101, Australia. Electronic address: z.tyack@uq.edu.au.
authors.forename: Z
authors.initials: Z
authors.lastname: Tyack
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002056:Burns / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000000981:diagnostic imaging* / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007223:Infant; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000379:methods*
keywords: Burn scar thickness; Cicatrix; Outcome measure; Pediatric; Ultrasound