Ultrasound is a reproducible and valid tool for measuring scar height in children with burn scars: A cross-sectional study of the psychometric properties and utility of the ultrasound and 3D camera

•High frequency ultrasound capable of detecting changes <1 mm in scar thickness.•Inter-rater and intra-rater reproducibility acceptable for scarred skin using ultrasound.•Using the difference measurement between normal and scarred skin score is not recommended.•Intra-rater reproducibility acceptable for maximal scar height using 3D camera.

ObjectiveThe aim of this study was to investigate the reproducibility and validity of measuring scar height in children using ultrasound and 3D camera.MethodUsing a cross-sectional design, children with discrete burn scars were included. Reproducibility was tested using Intraclass Correlation Coefficient (ICC) for reliability, and percentage agreement within 1 mm between test and re-test, standard error of measurement (SEM), smallest detectable change (SDC) and Bland Altman limits of agreement for agreement. Concurrent validity was tested using Spearman's rho for support of pre-specified hypotheses.ResultsForty-nine participants (55 scars) were included. For ultrasound, test-retest and inter-rater reproducibility of scar thickness was acceptable for scarred skin (ICC = 0.95, SDC = 0.06 cm and ICC = 0.82, SDC = 0.14 cm). The ultrasound picked up changes of <1 mm. Inter-rater reproducibility of maximal scar height using the 3D camera was acceptable (ICC = 0.73, SDC = 0.55 cm). Construct validity of the ultrasound was supported with a strong correlation between the measure of scar thickness and observer ratings of thickness using the POSAS (ρ = 0.61). Construct validity of the 3D camera was also supported with a moderate correlation (ρ = 0.37) with the same measure using maximal scar height.ConclusionsThe ultrasound is capable of detecting smaller changes or differences in scar thickness than the 3D camera, in children with burn scars. However agreement as part of reproducibility was lower than expected between raters for the ultrasound. Improving the accuracy of scar relocation may go some way to address agreement.