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Development of the pediatric patient scale of the Patient and Observer Scar Assessment Scale (POSAS) for burn scars:
Frederique M Kemme1, Matthea M Stoop2, Ingrid Parry3
1Alliance of Dutch Burn Care, Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands.
Insights
A new pediatric patient scale for the Patient and Observer Scar Assessment Scale (POSAS) was developed in Dutch and English. This tool assesses burn scar quality in children, incorporating their feedback and that of their parents.
Area of Science:
- Pediatric Scar Assessment
- Burn Scar Quality Evaluation
- Patient-Reported Outcomes
Background:
- The Patient and Observer Scar Assessment Scale (POSAS) is a widely used tool for scar quality assessment.
- The existing POSAS patient scale is not suitable for pediatric use.
- Burn scar assessment in children requires a child-centered approach.
Purpose of the Study:
- To develop Dutch and English pediatric patient versions of the POSAS.
- To assess burn scar quality specifically in children.
- To create a reliable and valid tool for pediatric burn scar evaluation.
Main Methods:
- Qualitative study involving semi-structured interviews with children (aged 8-17) and focus groups with parents.
- Thematic analysis of transcribed interviews and focus groups to identify key scar characteristics and response options.
- Development and pretesting of the pediatric POSAS scale with children and parents to ensure face validity.
Main Results:
- Inclusion of key scar characteristics such as pain, itch, tightness, color, and satisfaction with the scar.
- Development of a 5-point emoticon response scale for ease of use by children.
- The scale is adaptable for proxy reporting from the child's perspective (proxy-patient).
Conclusions:
- The Dutch and English pediatric POSAS patient scales have been successfully developed.
- These scales were created through collaboration with children, parents, and burn care professionals.
- Future validation studies are planned to confirm the measurement properties and reliability of the scales, including proxy reports.
Background:
The Patient and Observer Scar Assessment Scale (POSAS) is an internationally used tool to assess scar quality. The current patient scale, however, is not designed for use in children. This study aimed to develop the Dutch and English pediatric patient scale of the POSAS to assess burn scar quality in children.
Methods:
This qualitative study, conducted in 2023-2024, involved semi-structured interviews with children aged 8-17 with burn scars and focus groups with parents, in the Netherlands and the United States. The goal was to identify key scar quality characteristics and appropriate response options. Interviews and focus groups were audio-recorded, transcribed and thematically analyzed by two independent researchers using MAXQDA. The relevant characteristics were formulated into items for the Dutch and English version of the patient scale, supported by a multidisciplinary, international research team. The draft version was pretested with children and parents to evaluate face validity.
Results:
Twenty-one interviews with children and five focus groups with a total of 20 parents were conducted. The items satisfaction with the scar, color, bumpiness, pain, thickness, tightness, itch, hardness, lines, numbness, hair growth, and burning sensation are included in the scale. A 5-point emoticon response scale is used. The scale can also be completed by a proxy, instructed to report from the child's perspective (proxy-patient). Pretesting led to minor refinements.
Conclusions:
The Dutch and English pediatric patient scale of the POSAS are created based on input from children, parents, and burn care professionals. Validation studies will be performed to establish the measurement properties of the scale, including reliability of proxy-reported scores.
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