Comparison of Clinical Estimation and Stereophotogrammic Instrumented Imaging of Burn Scar Height and Volume

Round 1

Reviewer 1 Report (Previous Reviewer 1)

Comments and Suggestions for Authors

Thank you for the revised manuscript. I think the readers of the journal will be quite interested in your findings.

Author Response

Thank you for your commentary on the presented work.

Reviewer 2 Report (Previous Reviewer 2)

Comments and Suggestions for Authors

Thanks for the authors for revising their original manuscript. This work will be of importance for progressing implementation of outcome measures of clinimetric value in the clinical setting. 

Other points for consideration to improve the scientific rigour are:

1. report the patient's age (in Table 1) using mean and standard deviation, as well as the range

2. include justification of the sample size of N=26 scars

I would also recommend including the sample size (N=26 scars) in the abstract

Author Response

1. report the patient's age (in Table 1) using mean and standard deviation, as well as the range

This information has been included in Table 1. In reviewing the demographic data, it was noted that the youngest participant was 20. We had previously reported in table 1 the age range to be 21-68. This has been amended to 20-68. Thank you for helping us recognize this error.

 

2. include justification of the sample size of N=26 scars

This justification has been included in the methods section of our manuscript.

 

I would also recommend including the sample size (N=26 scars) in the abstract   

This information has now been incorporated into the abstract.

Reviewer 3 Report (Previous Reviewer 3)

Comments and Suggestions for Authors

Ok now for me.

Author Response

Thank you for your commentary on the presented work.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thanks. Interesting work. An objective measure of scar height/volume is badly needed. I think you should include table with at least a few scars' raw data, so that the reader could see the variability between subjective measurements as opposed to the algorithm's measurements.

1. The authors demonstrate that three dimensional imaging (using parallax photography and software) determines height and volume of hypertrophic burn scar with greater reproducibility than the subjective measurements of experienced therapists.

2. Hypertrophic burn scar is a vexing problem for burn survivors. Studies on the natural history of scars and the result of scar intervention are plagued by poor reproducibility. An objective measure of the size of a scar is badly needed. The authors demonstrate the use of a technology that may greatly reduce interobserver variability in scar assessment and could pave the way toward a universally approved objective measure of scar volume.

3. From my perspective the only improvement would be including a table with all of the raw data, so that the reader could see the impact of using the technology.

 

Author Response

Coverletter attached

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This paper describes the reliability of stereophotogrammetry to measure scar height and volume. The paper is well written and easy to follow - well done!

I have the following suggestions for the author's consideration:

- As ultrasound is currently the gold standard (pragmatically) for measuring total scar height insitu (versus stereophotogrammetry that measures scar height only above the surface of the skin), the authors need to provide more robust justification for the use of stereophotogrammetry in a research and clinical setting over ultrasound. 

- please provide more detail regarding justification of your sample size for the current study (N=26 scars)

- Please provide more detail in the methods about the patient's positioning for photographing, whether when pressure garments were removed prior to photographing (for example, 10 mins prior), was the lighting and room temperature consistent etc

- Given the known unreliability of assessing burn scars from photographs using the VSS and POSAS, please make it clearer in your discussion that the scar height and volume were estimated from photographs. For example, p6 line 186.

- Table 1 is a little confusing about what is age of patients vs scar - please check

- Please check p7 line 235 - is the word fame meant to be frame?

Finally, the relocation of scars in longitudinal research has been consistently identified as challenging. Given the authors are suggesting the benefit of using stereophotogrammetry in the clinical setting is to provide patients with real-time feedback regarding scar changes and effectiveness (or not) of scar treatments, it would be helpful for the authors to provide an opinion regarding how scar relocation when using the stereophotogrammetry for scar assessment would be addressed.

Author Response

Coverletter attached

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

 

The subject to measure scar volume is interesting but the problem in this manuscript is the methodology. It is very simple, which as such is not a dismerit but it is very minimally described.

 

The authors assessed the scar height and volume on 3D images and then did the same with computer 3D Track programme and then examined the interrater reliability and stated:

“Our findings suggest stereophotogrammic measurement  of scar height and volume to be more reliable than clinical estimation.”

 

In their previous paper (ref.22) they write: “Although they demonstrate good reliability and validity, major limitations intrinsic to the 3D LifeViz design warrant further investigation of stereophotogrammetry-based commercially available instruments.” In that study they used another device to measure the scar. Now the device was the 3D LifeViz. Is that the same camera as above?

 

What is the reliability of the device? How accurate it is? Is the clinical assessment of scar volume  on images a relevant method in any case?

If one likes to repeat the study based on the information in the methods and results section, it wouldn’t be possible.

Author Response

Coverletter attached

Author Response File: Author Response.pdf