Wallace Hilary J, Fear Mark W, Crowe Margaret M, Martin Lisa J, Wood Fiona M
Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA Australia.
Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, M318, 35 Stirling Highway, Crawley, 6009 WA Australia.
Burns Trauma. 2017 Jul 3;5:19. doi: 10.1186/s41038-017-0084-x. eCollection 2017.
There is a lack of rigorous research investigating the factors that influence scar outcome in children. Improved clinical decision-making to reduce the health burden due to post-burn scarring in children will be guided by evidence on risk factors and risk stratification. This study aimed to examine the association between selected patient, injury and clinical factors and the development of raised scar after burn injury. Novel patient factors were investigated including selected immunological co-morbidities (asthma, eczema and diabetes type 1 and type 2) and skin pigmentation (Fitzpatrick skin type).
A prospective case-control study was conducted among 186 children who sustained a burn injury in Western Australia. Logistic regression was used to explore the relationship between explanatory variables and a defined outcome measure: scar height measured by a modified Vancouver Scar Scale (mVSS).
The overall correct prediction rate of the model was 80.6%; 80.9% for children with raised scars (>1 mm) and 80.4% for children without raised scars (≤1 mm). After adjustment for other variables, each 1% increase in % total body surface area (%TBSA) of burn increased the odds of raised scar by 15.8% (95% CI = 4.4-28.5%). Raised scar was also predicted by time to healing of longer than 14 days (OR = 11.621; 95% CI = 3.727-36.234) and multiple surgical procedures (OR = 11.521; 1.994-66.566).
Greater burn surface area, time to healing of longer than 14 days, and multiple operations are independently associated with raised scar in children after burn injury. Scar prevention strategies should be targeted to children with these risk factors.
目前缺乏对影响儿童瘢痕转归因素的严谨研究。基于危险因素及风险分层的证据，将有助于改善临床决策，以减轻儿童烧伤后瘢痕造成的健康负担。本研究旨在探讨特定的患者、损伤及临床因素与烧伤后增生性瘢痕形成之间的关联。研究了一些新的患者因素，包括特定的免疫共病（哮喘、湿疹、1型和2型糖尿病）及皮肤色素沉着（菲茨帕特里克皮肤分型）。
在西澳大利亚州对186名烧伤儿童进行了一项前瞻性病例对照研究。采用逻辑回归分析解释变量与一个明确的结局指标之间的关系：采用改良温哥华瘢痕量表（mVSS）测量瘢痕高度。
该模型的总体正确预测率为80.6%；增生性瘢痕（>1mm）儿童的预测率为80.9%，无增生性瘢痕（≤1mm）儿童的预测率为80.4%。在对其他变量进行校正后，烧伤总面积（%TBSA）每增加1%，增生性瘢痕的发生几率增加15.8%（95%CI=4.4-28.5%）。愈合时间超过14天（OR=11.621；95%CI=3.727-36.234）及多次外科手术（OR=11.521；1.994-66.566）也可预测增生性瘢痕。
烧伤面积越大、愈合时间超过14天以及多次手术与儿童烧伤后增生性瘢痕独立相关。瘢痕预防策略应针对具有这些危险因素的儿童。
