Patient-reported scar quality in paediatric and adult burn patients: A long-term multicentre follow-up study

Burn scar maturation can take several years but is generally studied shortly after injury. Therefore, we investigated patient-reported scar quality up to 5–7 years post-burn. Patients with ≤ 20 % total body surface area burned completed the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS 2.0) on the same scar at three, > 18 months (median 28 months) and 5–7 years (median 63 months) post-burn. Fifty-eight patients (21 children; 37 adults) with a median total body surface area burned of 6.3 % participated. Average patient-reported scar quality (POSAS score) was generally worst at three months (median score: 4.2), best at 28 months (median score: 2.2) and in between at 63 months post-burn (median score: 3.4) (p < 0.001). Many patients (66 %) reported a median 1.8 point higher (worse) POSAS score at 63 months compared to 28 months post-burn, whereas 14 % reported an identical, and 21 % a lower (better) score. At any assessment, largest differences with normal skin were reported for scar colour. Univariate predictive factors of long-term patient-reported scar quality were scar quality at three months (p = 0.002) and 28 months post-burn (p < 0.001), percentage total body surface area full-thickness (p = 0.033), length of hospital stay (p = 0.003), and number of surgeries (p < 0.001). Two-third of patients with burns up to 20 % total body surface area burned scored the quality of their scars worse at 63 months compared to 28 months post-burn. Whether this corresponds to increased dissatisfaction with scars in the long-term should be further investigated. These new insights add to the body of knowledge on scar maturation and underscores the importance of discussing patients' expectations.