Nedelec Bernadette, Correa José A, Rachelska Grazyna, Armour Alexis, LaSalle Léo
School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
J Burn Care Res. 2008 May-Jun;29(3):489-500. doi: 10.1097/BCR.0b013e3181710869.
The comparison of scar evaluation over time requires measurement tools with acceptable intrarater reliability and the ability to discriminate skin characteristics of interest. The objective of this study was to evaluate the intrarater reliability and sensitivity and specificity of the Cutometer, the Mexameter, and the DermaScan C relative to the modified Vancouver Scar Scale (mVSS) in patient-matched normal skin, normal scar (donor sites), and hypertrophic scar (HSc). A single investigator evaluated four tissue types (severe HSc, less severe HSc, donor site, and normal skin) in 30 burn survivors with all four measurement tools. The intraclass correlation coefficient (ICC) for the Cutometer was acceptable (> or =0.75) for the maximum deformation measure for the donor site and normal skin (>0.78) but was below the acceptable range for the HSc sites and all other parameters. The ICC for the Mexameter erythema (>0.75) and melanin index (>0.89) and the DermaScan C total thickness measurement (>0.82) were acceptable for all sites. The ICC for the total of the height, pliability, and vascularity subscales of the mVSS was acceptable (0.81) for normal scar but below the acceptable range for the scar sites. The DermaScan C was clearly able to discriminate HSc from normal scar and normal skin based on the total thickness measure. The Cutometer was less discriminating but was still able to discriminate HSc from normal scar and normal skin. The Mexameter erythema index was not a good discriminator of HSc and normal scar. Receiver operating characteristic curves were generated to establish the best cutoff point for the DermaScan C total thickness and the Cutometer maximum deformation, which were 2.034 and 0.387 mm, respectively. This study showed that although the Cutometer, the DermaScan C, and the Mexameter have measurement properties that make them attractive substitutes for the mVSS, caution must be used when interpreting results since the Cutometer has a ceiling effect when measuring rigid tissue such as HSc and the Mexameter erythema index does not discriminate normal scar from HSc.
随着时间推移对瘢痕评估进行比较，需要使用具有可接受的评估者内信度且能够区分感兴趣的皮肤特征的测量工具。本研究的目的是评估皮肤弹性测定仪（Cutometer）、皮肤色素仪（Mexameter）和皮肤超声扫描C（DermaScan C）相对于改良温哥华瘢痕量表（mVSS）在患者匹配的正常皮肤、正常瘢痕（供区）和增生性瘢痕（HSc）中的评估者内信度、敏感性和特异性。一名研究者使用所有四种测量工具对30名烧伤幸存者的四种组织类型（重度HSc、轻度HSc、供区和正常皮肤）进行评估。皮肤弹性测定仪最大变形测量的组内相关系数（ICC）在供区和正常皮肤中可接受（≥0.75）（>0.78），但在HSc部位和所有其他参数中低于可接受范围。皮肤色素仪红斑（>0.75）和黑色素指数（>0.89）以及皮肤超声扫描C总厚度测量（>0.82）的ICC在所有部位均可接受。mVSS高度、柔韧性和血管性子量表总分的ICC在正常瘢痕中可接受（0.81），但在瘢痕部位低于可接受范围。基于总厚度测量，皮肤超声扫描C能够明确区分HSc与正常瘢痕和正常皮肤。皮肤弹性测定仪的区分能力较弱，但仍能够区分HSc与正常瘢痕和正常皮肤。皮肤色素仪红斑指数不是区分HSc和正常瘢痕的良好指标。生成了受试者工作特征曲线以确定皮肤超声扫描C总厚度和皮肤弹性测定仪最大变形的最佳截断点，分别为2.034和0.387毫米。本研究表明，尽管皮肤弹性测定仪（Cutometer）、皮肤超声扫描C（DermaScan C）和皮肤色素仪（Mexameter）具有使其成为mVSS有吸引力替代品的测量特性，但在解释结果时必须谨慎，因为皮肤弹性测定仪在测量如HSc等坚硬组织时存在天花板效应，且皮肤色素仪红斑指数无法区分正常瘢痕和HSc。
