Pruritus in the Pediatric Burn Population.

Postburn pruritus is a significant issue that can have a devastating impact on patient quality of life. Despite its known negative impact, few studies have focused on the pediatric population. Thus, the aim of this study was to determine the incidence of pruritus among pediatric burn patients as well as identify its predictive factors and commonly used treatments, including the novel use of laser therapy. A retrospective analysis of all burn patients treated at our pediatric burn center from 2009 to 2017 was conducted. The primary outcome measure was the presence or absence of pruritus at any point following the burn. One thousand seven hundred and eighty-three patients met the inclusion criteria for this study. The mean age at injury was 3.67 years (SD = 4.02) and the mean burn TBSA was 3.48% (SD = 4.81) with most burns resulting from scalds (66%). In total, 665 patients (37.3%) experienced pruritus. Following multivariable logistic regression, TBSA, age >5 years, burns secondary to fire/flame, and burn depth, were identified as significant predictors of pruritus (P < .05). Pruritus was treated with diphenhydramine (85.0%), hydroxyzine (37.3%), and gabapentin (4.2%) as well as massage (45.7%), pressure garments (20.0%), and laser therapy (8.6%). This study addresses the knowledge gap in the literature related to postburn pruritus among pediatric patients and includes one of the largest patient cohorts published to date. Moreover, the results further contribute to our understanding of postburn pruritus in children and may help us to predict which patients are most likely to be affected, so that treatment can be initiated as soon as possible.

Raising awareness of hand-arm vibration syndrome (HAVS) using posters.

BACKGROUND: Hand-arm vibration syndrome (HAVS) is caused by prolonged occupational exposure to hand-transmitted vibration. Although HAVS is preventable, disease awareness and prevention knowledge are lacking in high-risk workplaces; this may contribute to under-diagnosis, delays in seeking care, and poor health outcomes. Posters may be used to increase awareness in the workplace. OBJECTIVE: To conduct a pilot survey in workers with HAVS about poster use in their workplaces, their recommendations for poster campaigns and training programs, and their evaluation of HAVS awareness and prevention posters. METHODS: All eligible HAVS patients in the Occupational Health Clinic at St. Michael's Hospital, in Toronto, Canada, were asked to complete a questionnaire on workplace poster use and to evaluate a set of HAVS posters. RESULTS: Fifty workers participated; almost all were males, aged 50 and older, working in construction. Most indicated having non-HAVS specific awareness posters in their workplaces. There was a positive evaluation of the design, content, and potential usefulness of the posters. The poster depicting finger blanching stood out most. The poster depicting anti-vibration gloves rated highest for relatability and effectiveness at conveying disease importance. CONCLUSIONS: Participants supported the proposed use of industry-specific HAVS awareness posters in their workplaces. Future research should evaluate the effectiveness of these posters in the workplace.

Examining the Usefulness of ISO 10819 Anti-Vibration Glove Certification.

Anti-vibration gloves are commonly worn to reduce hand-arm vibration exposure from work with hand-held vibrating tools when higher priority and more effective controls are unavailable. For gloves to be marketed as 'anti-vibration' they must meet the vibration transmissibility criteria described in the International Organization for Standardization (ISO) standard 10819 (2013). Several issues exist with respect to the methodology used for glove testing as well as the requirements for glove design and composition in ISO 10819 (2013). The true usefulness of anti-vibration gloves at preventing hand-arm vibration syndrome (HAVS) is controversial, given that their performance is dependent on tool vibration characteristics and the anthropometrics of workers in real working conditions. The major risk associated with the use of anti-vibration gloves is that it will give employees and employers a false sense of protection against the negative effects of hand-transmitted vibration. This commentary examines the limitations of the current international standards for anti-vibration glove testing and certification, thereby calling into question the degree of protection that anti-vibration gloves provide against HAVS, and cautioning users to consider both their benefits and potential drawbacks on a case-by-case basis.

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.

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.