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Burns. 2012 Sep;38(6):796-801. doi: 10.1016/j.burns.2012.04.011. Epub 2012 Jun 4.

Values of patients and caregivers for donor site scars: an inter-observer analysis between patients and caregivers and prediction of cosmetic satisfaction.

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Quality Assurance & Process Innovation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.



The Patient and Observer Scar Assessment Scale (POSAS) is used to judge scars and involves patients and caregivers. Although the opinions of both are integrated, agreement between them is poorly investigated, especially in donor site scars (DSSs). Furthermore, it is unknown which POSAS-items are mostly associated with overall cosmetic satisfaction with the scar.


We included 106 DSS-patients. Twelve weeks after wound healing, patients and caregivers rated the DSS in vivo using the POSAS, comprising seven items. They were unaware of each other's judgment. Inter-observer reliability (IOR) was expressed as intra-class correlation coefficients (ICC). Items of the POSAS that best predicted patients' overall satisfaction were identified using multivariable regression analysis.


Eleven caregivers from different medical centers judged the DSSs. IOR for the POSAS items was 'moderate' at best regarding the item 'overall opinion' (ICC 0.44; 95% confidence interval 0.27-0.58). IORs regarding other POSAS-items were 'poor'. Itching and relief best predicted patients' overall satisfaction (total variance explained, R(2)=0.174). For caregivers, pigmentation and pliability were most predictive (R(2)=0.318).


Patients and caregivers appreciate different aspects of scar characteristics using the POSAS. This calls for shared decision-making, in which patient opinions are incorporated in the treatment choice.

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