Scar Free Foundation Centre for Burns Research, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
Burns. 2020 Feb;46(1):110-120. doi: 10.1016/j.burns.2019.05.008. Epub 2019 Nov 8.
Hypertrophic scars in burn survivors are a major cause of morbidity but the development of evidence based treatments is hampered by the lack of objective measurements of these scars. The objective of our study is to investigate the most accurate parameters for objective scar assessment and to create a combination score to facilitate the use of a panel of objective scar measurement tools.
Three independent assessors evaluated fifty five scar sites on fifty five burn patients with both the subjective modified Vancouver Scar Scale (mVSS) and a panel of objective measurement tools including the DSM II Colormeter, Cutometer, Dermascan high frequency ultrasound. The sensitivity and specificity of the objective scar parameters in predicting a mVSS score of 6 or more using the Receiving Operator Characteristic Area under the curve (ROC AUC) was then calculated and the most accurate parameters were combined to create an objective global scar score.
The ROC AUC values were found to be highest for the Dermascan scar thickness (0.897), dermal intensity and intensity ratio (0.914 and 0.919), Cutometer R0 value (0.942), and R0 ratio (0.944). For colour measurements, ratios of scar to normal skin performed better than the single parameters for both erythema and pigmentation measurements: DSM II Erythema ratio vs Erythema (0.885 vs 0.818), DSM II a* ratio vs a* (0.848 vs 0.741); DSM II Melanin ratio vs Melanin (0.854 vs 0.761), DSM II L* ratio vs L* (0.862 vs 0.767). Analysis of the ROC AUC with chi-square test values showed that the highest AUC (0.786) was obtained with the combination of the Cutometer R0, Dermascan scar thickness, intensity and their respective scar to normal skin ratios. A total score of 5 and above (out of 6 parameters) had the highest combined sensitivity (69.0%) and specificity (83.3%).
The objective parameters for the DSM II Colormeter, Cutometer and Dermascan high frequency ultrasound were all found to have moderate to strong ROC AUC values and combination of the Cutometer R0 and Dermascan scar thickness and intensity values can be used to create an objective global scar scale that can accurately differentiate patients with hypertrophic burn scarring from non-hypertrophic scars or normal skin.
烧伤幸存者的增生性瘢痕是发病率的主要原因，但由于缺乏对这些瘢痕的客观测量，基于证据的治疗方法的发展受到阻碍。我们的研究目的是探讨最准确的客观瘢痕评估参数，并创建一个综合评分，以方便使用一组客观的瘢痕测量工具。
三位独立评估者使用主观改良温哥华瘢痕量表（mVSS）和一组客观测量工具，包括 DSM II 比色计、皮肤弹性计、Dermascan 高频超声，对 55 例烧伤患者的 55 个瘢痕部位进行评估。然后，使用受试者工作特征曲线下的面积（ROC AUC）计算客观瘢痕参数预测 mVSS 评分≥6 的敏感性和特异性，并将最准确的参数组合以创建客观的整体瘢痕评分。
发现 Dermascan 瘢痕厚度（0.897）、真皮强度和强度比（0.914 和 0.919）、皮肤弹性计 R0 值（0.942）和 R0 比值（0.944）的 ROC AUC 值最高。对于颜色测量，与单一参数相比，瘢痕与正常皮肤的比值在红斑和色素沉着测量方面表现更好：DSM II 红斑比值与红斑（0.885 与 0.818）、DSM II a比值与 a（0.848 与 0.741）；DSM II 黑色素比值与黑色素（0.854 与 0.761）、DSM II L比值与 L（0.862 与 0.767）。使用卡方检验值对 ROC AUC 的分析表明，获得最高 AUC（0.786）的是结合皮肤弹性计 R0、Dermascan 瘢痕厚度、强度及其相应的瘢痕与正常皮肤比值。总分 5 分及以上（6 个参数中的 5 个）具有最高的综合敏感性（69.0%）和特异性（83.3%）。
DSM II 比色计、皮肤弹性计和 Dermascan 高频超声的客观参数均具有中等至较强的 ROC AUC 值，并且可以结合皮肤弹性计 R0 和 Dermascan 瘢痕厚度和强度值，以创建一个客观的整体瘢痕评分，可以准确地区分增生性烧伤瘢痕患者与非增生性瘢痕或正常皮肤。
