The Course of Scar Formation and Predictors of Scar Quality in 490 Paediatric Burn Patients During the First Year Post‐Burn

This study analysed the course of scar formation and predictors of scar quality in children during the first year post-burn. Scar quality was assessed using the Patient and Observer Scar Assessment Scale (POSAS; patient scale completed by caregiver or child) and Dermaspectrometer during routine follow-ups at the Burn Centre of the Red Cross Hospital, Beverwijk, the Netherlands between 2004 and 2022. Descriptive analyses examined scar characteristics over time. Multivariable regression analyses identified predictors of scar quality (POSAS overall opinion, thickness, pruritus) at 12 months. A total of 490 children (median age 2 years; 66% male) were included. Patient and observer overall opinion significantly improved between 6 and 12 months (p < 0.01). Most POSAS items improved over time, but observer thickness and relief scores initially slightly worsened before stabilising. Erythema and melanin differences with normal skin decreased significantly (p < 0.01). Patients (i.e., caregivers or children) consistently rated scars 1.5 points worse than observers. Observer-reported scar quality (overall opinion and thickness) was independently associated with burn severity (length of hospital stay, %TBSA full-thickness), burn cause, scar location and early scar characteristics (p < 0.10). Persistent pruritus (60%) was more prevalent than persistent pain (12%) and independently associated with age at burn and scar location (p < 0.05). Paediatric burn scars generally improve within the first year post-burn, most notably after 6 months, although pruritus remains common. Early scar characteristics appear informative for predicting scar outcomes. Our findings highlight the complexity of (predicting) scar formation and support early risk stratification for more personalised follow-up.