Patient-reported scar quality of adults after burn injuries: a five-year multicenter follow-up study

Inge Spronk, Suzanne Polinder, Juanita A. Haagsma, Marianne Nieuwenhuis, Anouk Pijpe, Cornelis H. van der Vlies, Esther Middelkoop, Margriet E. van Baar

Research output: Contribution to journalArticleAcademicpeer-review


Scar formation is an important adverse consequence of burns. How patients appraise their scar quality is often studied shortly after sustaining the injury, but information in the long-term is scarce. Our aim was, therefore, to evaluate long-term patient-reported quality of burn scars. Adults with a burn center admission of ≥1 day between August 2011 and September 2012 were invited to complete a questionnaire on long-term consequences of burns. We enriched this sample with patients with severe burns (>20% total body surface area [TBSA] burned or TBSA full thickness >5%) treated between January 2010 and March 2013. Self-reported scar quality was assessed with the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS). Patients completed this scale for their—in their opinion—most severe scar ≥5 years after burns. This study included 251 patients with a mean %TBSA burned of 10%. The vast majority (91.4%) reported at least minor differences with normal skin (POSAS item score ≥2) on one or more scar characteristics and 78.9% of the patients’ overall opinion was that their scar deviated from normal skin. Patients with severe burns had higher POSAS scores, representing worse scar quality, than patients with mild/intermediate burns, except for color, which was high in both groups. A longer hospital stay predicted reduced scar quality (both mean POSAS and mean overall opinion of the scar) in multivariate analyses. In addition, female gender was also associated with a poorer overall opinion of the scar. In conclusion, this study provides new insights in long-term scar quality. Scars differed from normal skin in a large part of the burn population more than 5 years after burns, especially in those with severe burns. Female gender is associated with a poorer patients’ overall opinion of their scar, which may be an indication of gender differences in perception of scar quality after burns.
Original languageEnglish
Pages (from-to)406-414
Number of pages9
JournalWound Repair and Regeneration: The International Journal of Tissue Repair and Regeneration
Issue number4
Publication statusPublished - 1 Jul 2019


  • scar quality
  • adults
  • burn injuries
  • follow-up studies


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