Reliability, validity and predictive validity of cutaneous functional units predicted to scar following palmar burn injury in young children


 Identification of children at risk of palmar burn scar is important for early initiation of scar management. This study determined the inter-rater reliability of face-to-face and photographic assessments of 29 palmar cutaneous functional units (CFUs), predicted to scar following palmar burn. The validity of photographic compared to face-to-face assessment, and the predictive validity of both assessment types to identify scarring at 3-6 months following burn, were also established. Thirty-nine children (40 hands) post burn injury were assessed face-to-face in the clinical setting, following healing of their palmar burn, by three burn therapists. Photographs of the children’s hands at initial assessment were assessed by the same therapists a minimum of six months later. To determine which CFUs scarred, children were reassessed face-to-face in the clinical setting 3-6 months following their burn. For analysis, 29 CFUs were merged into eight separate groups to determine the number of CFUs predicted to scar per CFU group for face-to-face and photographic assessments. The range of agreement for individual CFUs within CFU groups was also calculated for both assessment types. Excellent inter-rater reliability was established for face-to-face assessment in all eight CFU groups (ICC2,1 0.83-0.96). Photographic assessment demonstrated good to excellent inter-rater reliability in six CFU groups (ICC2,1 0.69-0.90) and validity in seven CFU groups (ICC2,1 0.66-0.87). Good to excellent predictive validity was established for both assessment types in seven CFU groups (face-to-face ICC2,1 0.60-0.95, photographic ICC2,1 0.69-0.89). Experienced therapists can reliably assess CFUs face-to-face or via photographs and predict future scar development.