title: The construction and implementation of a novel postburn pruritus scale for infants and children aged five years or less: introducing the Toronto Pediatric Itch Scale.
abstract: The authors' objectives were to design, refine, validate and implement a behavior-anchored postburn pruritus scale for children aged 5 years or less. We engaged a range of professionals involved in the care of children with burns. We used Q-methodology in interprofessional team exercises to identify and stratify itch behaviors into categories of increasing severity, and then iteratively refined these into a draft scale. We used a range of quantitative and qualitative techniques to assess the utility, feasibility, and validity of the scale and refined it accordingly. During the implementation phase we collected some preliminary reliability data. We generated a 4-point scale of itch severity with simple descriptors of each score. We also designed a separate guidance note and example behaviors that could be used to orientate new users without the need for rater training. End-user interviews revealed high levels of feasibility and content validity. The reliability data showed moderate inter-observer agreement, with a Cohen's kappa of 0.52 (P < .001). We have developed and implemented a behavioral post-burn pruritus scale for use in children aged less than 5 years and have demonstrated its utility, feasibility, validity, and reliability. The development of a validated symptom scoring scales will allow for the conduct of high-quality quantitative clinical trials and the subsequent implementation of evidence-based management protocols.
authors.affiliation: From the *Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario; †Department of Anesthesia, University of Toronto, Ontario; ‡Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario; and §Department of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Tobias
authors.initials: T
authors.lastname: Everett
authors.forename: Kathryn
authors.initials: K
authors.lastname: Parker
authors.forename: Joel
authors.initials: J
authors.lastname: Fish
authors.forename: Carolyne
authors.initials: C
authors.lastname: Pehora
authors.forename: Diandra
authors.initials: D
authors.lastname: Budd
authors.forename: Charis
authors.initials: C
authors.lastname: Kelly
authors.forename: Mark
authors.initials: M
authors.lastname: Crawford
authors.forename: Jason
authors.initials: J
authors.lastname: Hayes
mesh_terms: D000367:Age Factors; D002056:Burns / Q000150:complications*; D002652:Child Behavior; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D011537:Pruritus / Q000175:diagnosis* / Q000209:etiology* / Q000523:psychology; D015203:Reproducibility of Results; D012720:Severity of Illness Index