Inter-observer agreement on scar evaluation for uncomplicated appendicitis using a visual observer scale.

AIM OF THE STUDY To study the inter-observer agreement of a picture-based evaluation of esthetic results in pediatric patient treated with transumbilical (TUI) or subumbilical (SUI) incision for uncomplicated appendicitis (UA). Methods Parents of 43 children approached with SUI or TUI for UA in a 2-years-period agreed to send a scar’s image with Whatsapp. A 6-items qualitative [10 points Likert-like (1 best–10 worst)] and quantitative modified Visual Observer Scale (VOS) of Patient and Observer Scar Assessment Scale (POSAS) was independently attributed to each photograph by two observer trainees. Unpaired t-test for qualitative data (p significant <0.05) and Kappa statistic for inter-observer agreement of qualitative data were used for analysis. MAIN RESULTS A significant difference among observers were evidenced for each quantitative parameter of VOS (table). Inter-observer agreement for qualitative data resulted no agreement for simmetry (k=0.006), slight agreement for pigmentation and thickness (k=0.179 and 0.058, respectively), fair agreement for visibility (k=0.234) and depth (k=0.26), substantial agreement for hypertrophic scar (k=0.644). CONCLUSIONS A visual photographic evaluation of surgical scar can be interpreted by different observers with a large interindividual variability. Surgeon should not give to patients and/or caregivers their assessment of esthetic results without direct scar evaluation with validated instruments.