Subjective pediatric assessment scar scale - SPASS. Development and validation of the scale.

Background. Scarring is an inevitable outcome of traumatization of the skin after surgery. A skin scar is an important component of satisfaction with surgical treatment at any age. The clinical outcome of scarring on the skin can take various forms from barely noticeable whitish lines to the formation of pathological, keloid formations. Both the patient's comfort level and the possible treatment tactics depend on this. That is why the scar should be subject to systematization and evaluation at different stages of its formation, both from a quantitative standpoint and taking into account subjective perception.

Aim. Creation of a new tool for assessing a skin scar in a child. It should take into account the requirements of clinometry, the age and psychological characteristics of the child, be easy to understand and complete, as well as quick to interpret the results.

Methods. A total of 170 children participated in the study at various stages of the development and validation of the questionnaire scale. The inclusion criteria were: the presence of a skin scar acquired as a result of surgery, the period from the moment of surgery is more than a year, age 7-17 years, consent to participate in the study. The study period is from 2021 to 2024. The procedures of exploratory factor analysis and multiple regression analysis were carried out, taking into account all the standard criteria necessary for this. Spearman's criterion was chosen as a statistical criterion for comparing sets with each other.

Results. SPASS consists of three sheets with questions. Each of them is intended for personal filling by the child, his parent and, finally, the doctor. The questionnaire sheets for children are divided depending on the age periodization. The average level of inter–expert reliability among doctors was 0,96 (0,93 - 0,99; 95% CI). Intra–expert reliability had a variation from 0,85 (0,88 – 0,82; 95% CI) to 0,97 (0,95 - 0,99; 95% CI). The cumulative convergent validity value for the questionnaire was 0.95. The total Cronbach's α level for the data obtained among parents was 0,83.The overall subjective assessment of a skin scar significantly correlates positively with the following indicators: social aspects of the presence of a scar (R0 = 0,899, p < 0.001), physical inconveniences (R0 = 0,835, p < 0.001), problems of aesthetics and treatment (R0 = 0,733, p < 0.001).

Conclusion. Subjective pediatric assessment scar scale (SPASS) is the first tool of its kind to be used among children. The questionnaire is adapted for children of different ages, taking into account the periodization of mental development. The inclusion of the opinion of a doctor and a parent in the scale is innovative and allows us to most fully determine the subjective attitude to a skin scar in a child.