title: Pruritus in pediatric burn survivors: defining the clinical course.
abstract: Pruritus is a frequent and severe symptom and a significant cause of distress for adult burn patients. Its effects in children are largely unstudied. The aim of this study is to characterize postburn itch in the pediatric population. This is a retrospective review from 2006 to 2013 for pediatric burn survivors who were enrolled in a longitudinal multicenter outcomes study. Demographic data, injury characteristics, associated symptoms (skin-related problems, pain, and sleep), and incidence and intensity (Numerical Rating Scale) of itch were examined. Measures were completed at hospital discharge and at 6, 12, and 24 months after injury. Spearman's correlations were used to examine the correlation between itch intensity and associated symptoms. Multivariate regression analyses examined the impact of associated symptoms on itch intensity. There were 430 pediatric burn survivors with a mean age of 7.8 years and a mean TBSA of 40.8%. Pruritus is present in most children (93%) and is of moderate intensity (5.7 ± 3.1) at discharge. The frequency and intensity of pruritus decreases over time; a majority of children continue to report symptoms at 2 years (63%). Itch was significantly correlated with associated symptoms. Regression analyses showed a correlation between itch intensity and pain at each time point. There was no association between itch intensity and burn etiology, age, gender, or burn size. Pruritus is a frequent complication that lasts for at least 2 years after injury in a majority of pediatric burn survivors. This information will enable better tracking of outcomes and will serve as a baseline for assessing interventions.
authors.affiliation: From the *Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts; †Sumner Redstone Burn Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, Shriners Hospitals for Children®-Boston; ‡University of Texas Medical Branch, Shriners Hospitals for Children, Galveston; §Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center at Dallas; and ‖UW Medicine Regional Burn Center, University of Washington, Seattle.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Schneider
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Nadler
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
authors.forename: Karen
authors.initials: K
authors.lastname: Kowalske
authors.forename: Katie
authors.initials: K
authors.lastname: Matthews
authors.forename: Shelley A
authors.initials: SA
authors.lastname: Wiechman
authors.forename: Gretchen J
authors.initials: GJ
authors.lastname: Carrougher
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Gibran
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Meyer
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sheridan
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Ryan
mesh_terms: D000293:Adolescent; D002056:Burns / Q000150:complications* / Q000473:pathology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care; D011537:Pruritus / Q000175:diagnosis / Q000453:epidemiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors