Development of the pediatric patient scale of the Patient and Observer Scar Assessment Scale (POSAS) for burn scars: A qualitative study

Background The Patient and Observer Scar Assessment Scale (POSAS) is an internationally used tool to assess scar quality. The current patient scale, however, is not designed for use in children. This study aimed to develop the Dutch and English pediatric patient scale of the POSAS to assess burn scar quality in children. Methods This qualitative study, conducted in 2023–2024, involved semi-structured interviews with children aged 8–17 with burn scars and focus groups with parents, in the Netherlands and the United States. The goal was to identify key scar quality characteristics and appropriate response options. Interviews and focus groups were audio-recorded, transcribed and thematically analyzed by two independent researchers using MAXQDA. The relevant characteristics were formulated into items for the Dutch and English version of the patient scale, supported by a multidisciplinary, international research team. The draft version was pretested with children and parents to evaluate face validity. Results Twenty-one interviews with children and five focus groups with a total of 20 parents were conducted. The items satisfaction with the scar , color, bumpiness, pain, thickness, tightness, itch, hardness, lines, numbness, hair growth, and burning sensation are included in the scale. A 5-point emoticon response scale is used. The scale can also be completed by a proxy, instructed to report from the child’s perspective (proxy-patient). Pretesting led to minor refinements. Conclusions The Dutch and English pediatric patient scale of the POSAS are created based on input from children, parents, and burn care professionals. Validation studies will be performed to establish the measurement properties of the scale, including reliability of proxy-reported scores.