Assessment of Clinical Outcome after Flashlamp Pumped Pulsed Dye Laser Treatment of Portwine Stains: A Comprehensive Questionnaire

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Abstract
A generally accepted method to assess the clinical outcome of laser treatment of portwine stains is not available. This paper describes the development and evaluation of a comprehensive questionnaire for the assessment of the following portwine stain characteristics: color (hue and lightness), sharpness of boundary, pigmentation, size, shape, skin surface-structure, and hypertrophy of underlying tissue. The questionnaire was applied to photographs of 70 patients with previously untreated portwine stains in the head/neck area. Photographs were taken before treatment and after five treatments of the entire portwine stain with a flashlamp pumped pulsed dye laser. Each photograph was evaluated separately by a panel of five professionals: the treating physician, two plastic surgeons, a dermatologist, and a clinical photographer. Treatment results were assessed by comparing ratings before and after treatment. Agreement among raters was acceptable for all portwine stain characteristics, as was shown by weighted kappa analysis. The reliability of the answers was further improved by taking the average rating of the five panel members. The scores thus obtained were very reliable, with Cronbach alpha coefficients of 0.8 on average. After five treatments of the entire portwine stain, the most considerable changes were measured in the ratings for color (lightening of the stain by 33 percent), boundary (sharpness reduced by 38 percent), and size (13-percent decrease). Using the questionnaire can be helpful in the design of comparative clinical trials on portwine stain treatment and may facilitate comparison of treatment results between different treatment centers and/or different laser