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Updated: Feb 27, 2026
Severe Burn Injury in a Swine Model for Clinical Dressing Assessment
Published on: November 6, 2018
Identification of factors predicting scar outcome after burn injury in children: a prospective case-control study
Hilary J Wallace1,2, Mark W Fear1, Margaret M Crowe3
1Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA Australia.
Insights
Larger burn surface area, delayed healing over 14 days, and multiple surgeries increase raised scar risk in children. Early identification of these factors aids scar prevention strategies.
Area of Science:
- Pediatric surgery
- Dermatology
- Burn research
Background:
- Limited research exists on factors influencing pediatric burn scar outcomes.
- Evidence-based risk stratification is needed for improved clinical decision-making in pediatric burn scarring.
- This study investigated novel patient factors, including immunological comorbidities and skin pigmentation, alongside injury and clinical factors.
Purpose of the Study:
- To examine the association between patient, injury, and clinical factors and the development of raised scars in children post-burn.
- To identify key predictors of adverse scar outcomes in pediatric burn patients.
Main Methods:
- A prospective case-control study involving 186 children with burn injuries in Western Australia.
- Logistic regression analysis was employed to determine relationships between variables and scar height.
- Scar height was measured using a modified Vancouver Scar Scale (mVSS).
Main Results:
- The predictive model achieved an overall correct prediction rate of 80.6%.
- Increased percentage of total body surface area (%TBSA) burned significantly correlated with higher odds of raised scar (15.8% increase per 1% TBSA).
- Healing time exceeding 14 days and multiple surgical procedures were strong predictors of raised scar development.
Conclusions:
- Greater burn surface area, delayed healing (>14 days), and multiple operations are independent risk factors for raised scars in children.
- Scar prevention strategies should focus on pediatric patients presenting with these identified risk factors.
- Further research into immunological comorbidities and skin pigmentation as scar predictors is warranted.
Background:
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).
Methods:
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).
Results:
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).
Conclusions:
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.
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