Utility of a Multidisciplinary Burn OT Clinic in Early Identification of Hypertrophic Burn Scars

The literature indicates acute and long-term treatment for pediatric burn injuries have significantly improved since the 1960s with changes in available interventions and compression therapy (Sharp et al., 2016). The pediatric surgery team at a Level 1 Trauma Center identified a delay in referrals to rehabilitation post-burn recovery and worked in conjunction with occupational therapy (OT) to create a multidisciplinary clinic to optimize interventions for scar management. A case series research design was utilized, and the team of surgery advanced practice providers determined a biweekly outpatient clinic with OT would adequately capture new consultations and scar surveillance visits. The Vancouver Scar Scale (VSS) is a widely utilized assessment to characterize scar vascularity, pigmentation, pliability, and height. The VSS assessment was completed by the OT for pediatric burn patients that were referred for evaluation in clinic over a 24-month period. Demographics and scar characteristics were collected. Scar appearance indicated by the VSS score and the recommendation for compression garments was then completed. 70 pediatric burn patients between 9 months and 17 years old (44 male, and 26 female) were evaluated by the OT for initial consultation or follow-up assessment for surveillance. Results indicated the mean VSS score was 6.39 with the score range noted between 1-12. Custom compression garments were recommended to approximately 87% of subjects based on the risk of joint and skin contractures and scar characteristics of the VSS score. Based on this collaborative intervention, there is a higher correlation between poorer VSS scores and referrals to OT for compression garments. This clinic allowed for earlier intervention and closer surveillance, thereby potentially preventing worsening hypertrophic scarring. Further studies are needed to assess the multidisciplinary team approach with pediatric burns to provide interventions for acute and long-term scarring.

References

Sharp, P.A., Pan, B., Yakuboff, K.P., & Rothchild, D. (2016). Development of a Best Evidence Statement for the Use of Pressure Therapy for Management of Hypertrophic Scarring. Journal of Burn Care & Research, 37(4), 255–264. https://doi.org/10.1097/bcr.0000000000000253.

Wallace, H. J., Fear, M. W., Crowe, M. M., Martin, L. J., & Wood, F. M. (2017). Identification of Factors Predicting Scar Outcome after Burn Injury in Children: A Prospective Case-Control Study. Burns Trauma, 5(19). https://doi.org/10.1186/s41038-017-0084-x.

Tran, S., Han, S., Saade Daoud, M., & Gupta, D. (2023). 754 A Longitudinal Study of Compression Therapy in Pediatric Burn Patients. Journal of Burn Care & Research, 44(2), S159. https://doi.org/10.1093/jbcr/irad045.228

Busche, M. N., Thraen, A. J., Gohritz, A., Rennekampff, H. O., & Vogt, P. M. (2018). Burn Scar Evaluation Using the Cutometer® MPA 580 in Comparison to “Patient and Observer Scar Assessment Scale” and “Vancouver Scar Scale”. Journal of Burn Care & Research, 39(4), 516–526. https://doi.org/10.1093/jbcr/irx009