Title: A prospective study to examine the validity of a panel of objective burn scar measurement tools (BOSS II)
Funder: The Scar Free Foundation

Abstract: Reliable scar assessment is essential not only when designing clinical trials to investigate the efficacy of new and existing scar therapies, but also in everyday, clinical practice, to examine the progress of our patients’ care. Subjective assessments are extremely important; they demonstrate to the patient the changes and improvements in their scars since the primary burn injury. Nevertheless, as clinicians, we require reliable, validated, and objective tools which can yield measurable and reproducible outcomes. These are ultimately needed to achieve our goal of reducing the physical and psychosocial burden of scarring through compelling research. Previously, we conducted a pilot study (BOSS-1) in 55 patients with post burn hypertrophic scars. We measured, among other parameters, scar thickness, density, and pliability, using a panel of objective scar assessment tools, alongside standard subjective measurements (questionnaire-based), and skin biopsy assessments. Measurements were performed at a single time point which varied from 3 months to 6 years post burn injury. This work indicated that measuring scar thickness, pliability and colour together, may provide a global scar objective score.Here we will conduct a multi-centre study to validate these preliminary findings. We will recruit 60 burn patients with a burn wound >10cm2 that did not achieve 90% wound healing at 3 weeks post injury. Healed wounds will be assessed at 4 time points (3, 12, 18 and 24 months) from time of injury until scar maturation. From the time of recruitment (3 weeks post injury) the open wounds will be closely monitored (clinical assessments, photography and trans epidermal water loss (TEWL)) until time of complete wound closure which will be recorded. The time to healing will be used as a “recognised standard” to validate both the objective and the subjective tools; time to healing has previously been shown to correlate with severity of hypertrophic scarring (1-5). A panel of tools, rather than a single device, has been selected since they capture all scar characteristic changes (thickness, pliability and colour) during the scar maturation process. These objective measurements along with subjective (e.g. POSAS, Vancouver) assessments will be recorded at each time point.The proposed project will: (1) Allow us to validate the global burn objective scar score, identified in BOSS-1 study; ( (2) Correlate objective versus subjective measures; (3) Assess the acceptability of the global scar score with clinicians and patients. The creation of a validated panel of objective scar measurement devices will form the basis of future scar therapy research (outcome measures for clinical trials). These tools coupled with the haematological and histological data will further our understanding of the process of burn scar maturation and guide future care management.

Lay abstract: Historically, research into scar treatments has been hindered by the lack of an objective measurement that accurately tests the impact of a burn injury treatment. Measuring the usefulness of treatment has traditionally been carried out using scar questionnaires – but results from this method tend to vary between patients due to the subjective nature of the current tools.This study is assessing a group of patients from the time of their injury to the time of wound healing and for 2 years. The team is measuring their scars with a range of objective scar measuring tools that have been shown to work in a previous smaller study alongside subjective questionnaires that look at how the patients view their own scars, and the effect these scars have on their quality of life.

Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION;2.5 RESEARCH DESIGN AND METHODOLOGIES (AETIOLOGY)
Health categories: INJURIES AND ACCIDENTS;SKIN