ASSESSMENT OF CLINICAL OUTCOME AFTER FLASHLAMP-PUMPED PULSED DYE-LASER TREATMENT OF PORTWINE STAINS - A COMPREHENSIVE QUESTIONNAIRE

A generally accepted method to assess the clinical outcome of laser tr eatment of portwine stains is not available. This paper describes the development and evaluation of a comprehensive questionnaire for the as sessment of the following portwine stain characteristics: color (hue a nd lightness), sharpness of boundary, pigmentation, size, shape, skin surface-structure, and hypertrophy of underlying tissue. The questionn aire was applied to photographs of 70 patients with previously untreat ed portwine stains in the head/neck area. Photographs were taken befor e treatment and after five treatments of the entire portwine stain wit h a flashlamp pumped pulsed dye laser. Each photograph was evaluated s eparately by a panel of five professionals: the treating physician, tw o plastic surgeons, a dermatologist, and a clinical photographer. Trea tment results were assessed by comparing ratings before and after trea tment. Agreement among raters was acceptable for all portwine stain ch aracteristics, as was shown by weighted kappa analysis. The reliabilit y of the answers was further improved by taking the average rating of the five panel members. The scores thus obtained were very reliable, w ith Cronbach alpha coefficients of 0.8 on average. After five treatmen ts of the entire portwine stain, the most considerable changes were me asured in the ratings for color (lightening of the stain by 33 percent ), boundary (sharpness reduced by 38 percent), and size (13-percent de crease). Using the questionnaire can be helpful in the design of compa rative clinical trials on portwine stain treatment and may facilitate comparison of treatment results between different treatment centers an d/or different lasers.