Burn-induced cosmetic disfigurement: can it be measured reliably?

Cosmetic disfigurement was measured reliably by averaging the ratings of four or more viewers of color slide photographs of severely burned children and young adults. Raters were clinical and nonclinical staff at a burn hospital. Reliability for four-person rating of overall cosmetic disfigurement (unclothed) was .94; for overall disfigurement (clothed) it was .86; for irregularity, thickness, and discoloration it was .78, .79, and .72, respectively. Profession, sex, and years of contact with burned patients did not influence inter-rater agreement. Any randomly selected panel of four raters produced reliable average ratings. The effect of impaired skin texture on overall ratings of cosmetic disfigurement (both clothed and unclothed) was three to five times as important as the effect of impaired color. Despite its subjectivity, cosmetic disfigurement can be measured reliably. This report describes a formal procedure for such measurement and discusses ways of using that procedure to improve patient care.