Dr Sam Hamilton1, Dr Katherine Davis1, Mr Nanda Kandamany1
1Department of Plastic and Reconstructive Surgery, Royal Hobart Hospital, Sandy Bay, Australia
It has been found that up to 93% of adult burns patients report itching (Nedelec B & LaSalle L, 2018). The ISBI Practice Guidelines Committee (2016) recommends the first stage in the management of itch is to assess the intensity, a task that can be particularly challenging in children. We aim to provide a brief overview of the assessment tools available to assist in the evaluation of itch in burns patients.
A comprehensive search of Pubmed was performed using broad search terms.
There are seven different tools available for the assessment of itch which have been validated in an English language population. There is no consensus on a gold standard evaluation tool to date (Nedelec B & LaSalle L, 2018).
The Numeric Rating Scale (NRS) and Visual Analogue Scale (VAS) are commonly used in the evaluation of itch, simply giving a number or picture to “itch severity”, similar in use to a pain scale. The Itch Man, a five-point Likert scale, works on similar principles (Morris V et al, 2012), and is useful in the paediatric population. The Toronto Paediatric Itch Scale, developed by Everett et al (2015) is for use on children under five years old. It is observational, with care providers monitoring behaviour and applying to a five-point scale. Unfortunately, it has only moderate inter-observer agreement and may not be overly reliable.
There is far more to the impact of itch than just the severity on quality of life, with episode duration and frequency being important factors (Nedelec B et al, 2012). The 5-Dimension (5-D) Itch Scale (Elman et al, 2009) considers degree duration, direction, disability and distribution of itch, and has also been modified to a 4-Dimension Scale (Amtmann et al, 2017). The Burns Itch Questionnaire (Van Loey et al, 2016) uses itch severity, sleep interference and daily life interference to impact of post-burn itch.
In the measurement of itch, it is important to consider factors other than just intensity. There are several validated tools to assist in the assessment of itch.
Sam is currently a surgical RMO at the Royal Hobart Hospital. He has a strong interest in plastic surgery and burns management.