Epidemiology and Impact of Scarring Following Burn Injury: A Systematic Review of the Literature
CITATION: Lawrence JW, Mason ST, Schomer K, Klein MB. (2011). Epidemiology and Impact of Scarring Following Burn Injury: A systematic review of the literature. J. of Burn Care & Research. (accepted).
INTRODUCTION: The purpose of this study was to perform a systematic review of the existing literature on the incidence of hypertrophic scarring and the psychosocial impact of burn scars.
METHODS: In a comprehensive literature review, we identified 48 articles published since 1965 and written in English that reported the incidence and risk factors for hypertrophic scarring or assessed outcomes related to scarring.
RESULTS: Most studies had important methodological limitations limiting the generalizability of the findings. In particular, the absence of standardized valid measures of scarring and other outcome variables was a major barrier to drawing strong conclusions. Among studies on hypertrophic scarring, the prevalence rate varied between 32% and 72%. Identified risk factors included: dark skin, female gender, young age, burn site on neck and upper limb, multiple surgical procedures, meshed skin graph, time to healing, and burn severity. In regards to psychosocial outcomes, two studies compared pediatric burn survivors to a non-burn comparison group on a body image measure; neither study found differences between groups. Across studies, burn severity and location had a modest relationship with psychosocial outcome variables. Psychosocial variables such as social comfort and perceived stigmatization were more highly associated with body image than burn characteristics.
CONCLUSIONS: In order to advance our knowledge of the epidemiology of scars and the burden of scars, future studies need to implement more rigorous methodologies. In particular, we need to develop standardized valid measures of scarring and other outcomes. This process could be facilitated by an international collaboration among burn centers.