Development and validation of a novel scar evaluation scale

Background: The authors previously developed a six-item ordinal wound evaluation scale to measure the short-term cosmetic outcome of wounds I week after injury. Although it was never intended to measure long-term outcomes, it has been used to assess scars 3 to 12 months after injury. The authors developed and validated a scar evaluation scale specifically aimed at measuring the long-term appearance of scars. Methods: Two plastic surgeons and one emergency physician, blinded to each other's assessments, viewed photographs of 50 scars resulting from lacerations or surgical incisions. Scars were assigned 0 or 1 point each for the presence or absence of the following: width greater than 2 mm, elevation or depression, discoloration, suture or staple marks, and overall poor appearance. A total cosmetic score was then calculated by adding the individual scores on each of the five categories ranging from 0 (worst) to 5 (best). Scars were also scored on a validated 100-mm visual analogue scale marked "worst scar" and "best scar" at the low and high ends, respectively. Pairwise interobserver agreement was calculated. Results: Interobserver agreement for the total scores on the scar evaluation scale was 0.73, 0.75, and 0.85 (p < 0.001 for all). Interobserver correlations on the visual analogue scale were 0.83, 0.86, and 0.87 (p < 0.001 for all). Correlations between the total scar evaluation scale and visual analogue scale scores were 0.75, 0.86, and 0.92. Visual analogue scale scores were significantly higher as scar evaluation scale scores increased (analysis of variance, p < 0.001). Conclusion: The authors describe a new long-term scar evaluation scale that is highly reliable and correlated with the cosmetic visual analogue scale, suggesting construct validity.