783 Scar Revisions: Are We Asking the Right Questions?
Bibliographic record
Abstract
Abstract Introduction Scars have wide-ranging effects on the individual and as such, many seek to have their scars. Currently, there is no gold standard for conducting scar revision consults. Scar-specific patient-reported outcome measures (PROM) are questionnaires created by individuals with scars and encompass all concepts of interest (COI) important to them. PROMs can be used for quality improvement (QI) initiatives to determine if all COI are being asked of patients. SCAR-Q, a new, internationally validated, scar-PROM measuring COI related to scar appearance, symptoms and function, and psychosocial impact was used. The purpose of this QI study was to determine if COI important to patients with scars are routinely asked during scar revision consults. Methods All scar revisions consults from July 1, 2017 to June 30, 2019 were reviewed at a single pediatric hospital using an electronic database. This study represents Phase 1 of the QI study approved by the institution and follows Model for Improvement methodology. Inclusion criteria were: patient aged ≥8 years, had a cutaneous scar, and speak English. Demographic information included: gender, age; and items related to the patient’s scar including etiology, time since injury, location, interventions; COI encompassed by SCAR-Q. Results 162 electronic patient charts were reviewed with 88 meeting inclusion criteria. 45 were females (51.1%) with an average age of 12.6(SD 3.1, 8–20 years) with time since injury scar of 4.0 years (SD4.6,1 month-17 years). Burns, specifically scalds (18,45.0%) were the most common etiology (40,45%). Scars were located predominantly on the face/scalp (34,39.5%), chest (16,18.6%), and arm (15,17.4%). Most patients had no previous scar intervention at the time of the consultation (43, 51.2%). No scar revision consults encompassed all COI as defined by the SCAR-Q with appearance and Symptom/Function questions being more common than Psychosocial (Table 1). Specifically, scar color, hardness/thickness, disliking the scar were the most frequently asked questions (Table 2). Conclusions There is currently no established gold standard for conducting scar revision consults. SCAR-Q, a newly validated scar-specific PROM was used to determine if all questions that are important to individuals with scars were asked during routine scar revision consults. The most common questions asked of individuals with scars were related to appearance followed closely by symptoms/functional implications. Questions related to psychosocial impact are not routinely asked and represent a large area of improvement. Next steps include implementing a scar-specific PROM to ensure that all COI are implemented in routine clinical care. Applicability of Research to Practice This research is applicable to practice as it shows that PROM can be utilized for QI studies including identifying areas that are lacking in scar revision consults.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.032 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.016 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".