Background Laser therapy has emerged to play a valuable role in the treatment of paediatric burn scars; however, there is heterogeneity in the literature, particularly concerning optimal timing for initiation of laser therapy. This study aims to investigate the effect of factors such as scar age, type of laser and laser treatment interval on burn scar outcomes in children by meta-analysis of previous studies. Methods A literature search was conducted across seven databases in May 2022 to understand the effects of laser therapy on burn scar outcomes in paediatric patients by metanalysis of standardized mean difference (SMD) between pre- and post-laser intervention. Meta-analyses were performed using the Comprehensive Meta-Analysis software version 4.0. Fixed models were selected when there was no significant heterogeneity, and the random effects model was selected for analysis when significant heterogeneity was identified. For all analyses, a p-value < 0.05 was considered significant. Results Seven studies were included in the meta-analysis with a total of 467 patients. Laser therapy significantly improved Vancouver Scar Scale (VSS)/Total Patient and Observer Scar Assessment Scale (Total POSAS), vascularity, pliability, pigmentation and scar height of burn scars. Significant heterogeneity was found between the studies and thus subgroup analyses were performed. Early laser therapy (<12 months post-injury) significantly improved VSS/POSAS scores compared to latent therapy (>12 months post-injury) {SMD −1.97 [95% confidence interval (CI) = −3.08; −0.87], p < 0.001 vs −0.59 [95%CI = −1.10; −0.07], p = 0.03} as well as vascularity {SMD −3.95 [95%CI = −4.38; −3.53], p < 0.001 vs −0.48 [95%CI = −0.66; −0.30], p < 0.001}. Non-ablative laser was most effective, significantly reducing VSS/POSAS, vascularity, pliability and scar height outcomes compared to ablative, pulse dye laser and a combination of ablative and pulse dye laser. Shorter treatment intervals of <4 weeks significantly reduced VSS/POSAS and scar height outcomes compared to intervals of 4 to 6 weeks. Conclusions Efficacy of laser therapy in the paediatric population is influenced by scar age, type of laser and interval between laser therapy application. The result of this study particularly challenges the currently accepted initiation time for laser treatment. Significant heterogeneity was observed within the studies, which suggests the need to explore other confounding factors influencing burn scar outcomes after laser therapy.

中文翻译：

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疤痕年龄、激光类型和激光治疗间隔对儿童烧伤疤痕的影响：系统评价和荟萃分析

背景 激光疗法已在儿童烧伤疤痕的治疗中发挥着重要作用。然而，文献中存在异质性，特别是在开始激光治疗的最佳时机方面。本研究旨在通过对既往研究的荟萃分析，探讨疤痕年龄、激光类型和激光治疗间隔等因素对儿童烧伤疤痕结局的影响。方法 2022 年 5 月，我们对七个数据库进行了文献检索，通过对激光干预前后标准化平均差 (SMD) 进行荟萃分析，了解激光治疗对儿科患者烧伤疤痕结果的影响。使用综合荟萃分析软件 4.0 版进行荟萃分析。当不存在显着异质性时选择固定模型，当发现显着异质性时选择随机效应模型进行分析。对于所有分析，p 值 < 0.05 被认为是显着的。结果荟萃分析纳入7项研究，共467名患者。激光治疗显着改善了温哥华疤痕量表（VSS）/总患者和观察者疤痕评估量表（总 POSAS）、烧伤疤痕的血管分布、柔韧性、色素沉着和疤痕高度。研究之间发现显着的异质性，因此进行了亚组分析。与潜伏治疗（受伤后>12个月）相比，早期激光治疗（受伤后<12个月）显着改善了VSS/POSAS评分{SMD -1.97 [95%置信区间（CI）= -3.08； -0.87]，p＜ 0.001 对比 -0.59 [95%CI = -1.10； −0.07], p = 0.03} 以及血管分布 {SMD −3.95 [95%CI = −4.38; -3.53]，p＜ 0.001 对比 -0.48 [95%CI = -0.66； -0.30]，p＜ 0.001}。与烧蚀性、脉冲染料激光以及烧蚀性和脉冲染料激光的组合相比，非烧蚀性激光是最有效的，可显着减少 VSS/POSAS、血管分布、柔韧性和疤痕高度结果。与4至6周的间隔相比，＜4周的较短治疗间隔显着降低了VSS/POSAS和疤痕高度结果。结论 儿童激光治疗的疗效受到疤痕年龄、激光类型和激光治疗应用间隔的影响。这项研究的结果特别挑战了目前公认的激光治疗起始时间。研究中观察到显着的异质性，这表明需要探索影响激光治疗后烧伤疤痕结果的其他混杂因素。