Simons Megan, Tyack Zephanie
Occupational Therapy Department, Royal Children's Hospital, Herston, Brisbane, Queensland, Australia.
J Burn Care Res. 2011 Mar-Apr;32(2):275-85. doi: 10.1097/BCR.0b013e31820aaf09.
With advances in wound care technology, there is a trend toward patients undertaking specialist burns treatment in an outpatient capacity. Photographic scar evaluation is a part of this trend in some health services because it permits scar assessment by different health professionals, both within and across outpatient services, to assess the impact of scar management strategies. The aim of this study was to explore the parameters considered integral to scar assessment when completing photographic scar evaluation. First, opinions were sought from 38 burn health professionals in 2 tertiary pediatric hospitals who participated in focus groups where in-person and in-photograph scar rating were completed using three burn scar rating scales (modified Vancouver scar scale, Manchester scar scale, and patient and observer scar assessment scale) presented with a standard format and instructions. Second, 36 occupational therapists and physiotherapists from Australia and New Zealand completed questionnaires. Third, 10 healthcare consumers from 1 tertiary pediatric hospital participated in face-to-face or telephone interviews. Parameters believed to be assessed using photographic evaluation of burns scarring were vascularity, surface area, color, contour, height, and overall opinion. However, surface area was considered questionable as an indicator of scar maturity. These parameters mostly differ from those considered important in a burn scar outcome measure when rating scars in-person: height/thickness, vascularity, color, pliability, joint function, and patient/client opinion. A categorical scale with visual descriptors, as well as specific strategies to improve photographic technique, may go some way to addressing the perceived difficulty in rating these parameters using burn scar photographs.
随着伤口护理技术的进步，患者以门诊形式接受专科烧伤治疗的趋势日益明显。在一些医疗服务中，瘢痕摄影评估是这一趋势的一部分，因为它允许不同的医疗专业人员在门诊服务内部和之间进行瘢痕评估，以评估瘢痕管理策略的效果。本研究的目的是探讨在进行瘢痕摄影评估时，被认为是瘢痕评估不可或缺的参数。首先，研究人员征求了两家三级儿科医院的38名烧伤医疗专业人员的意见，这些人员参与了焦点小组，在小组中使用三种烧伤瘢痕评级量表（改良温哥华瘢痕量表、曼彻斯特瘢痕量表以及患者和观察者瘢痕评估量表），按照标准格式和说明对实际瘢痕和照片中的瘢痕进行评级。其次，来自澳大利亚和新西兰的36名职业治疗师和物理治疗师完成了问卷调查。第三，来自一家三级儿科医院的10名医疗消费者参与了面对面或电话访谈。人们认为，通过烧伤瘢痕的摄影评估来测量的参数包括血管分布、表面积、颜色、轮廓、高度和总体评价。然而，表面积作为瘢痕成熟度的指标存在疑问。这些参数与在对实际瘢痕进行评级时，烧伤瘢痕结局测量中认为重要的参数（高度/厚度、血管分布、颜色、柔韧性、关节功能以及患者/客户评价）大多不同。一个带有视觉描述符的分类量表以及改进摄影技术的具体策略，可能在一定程度上解决了使用烧伤瘢痕照片对这些参数进行评级时所感知到的困难。
