Guidelines for the treatment of Post-Burns Pruritus at The Children’s Hospital at Westmead

Miss Madeleine Jacques1, Dr Mahmoud El Bably1, Dr  Mitchell Nash1, Dr Alan Pham1

1The Children’s Hospital at Westmead

Pruritus in burns patients is common and distressing.

The mechanism of burn itch is complex and understood to have both central and peripheral pathways. Predictors of severe and/or prolonged pruritus include larger body surface area burns, burns of greater depth, grafting (with particular consideration of donor sites), hypertrophic scars and female gender.

Assessment and treatment of burn pruritus in the paediatric population is an area of great challenge. Unmanaged pruritus may ultimately lead to wound breakdown and/or delayed wound healing.

Early detection of the above predictors and early/aggressive (and in some cases pre-emptive) therapy is strongly advocated.

There is a paucity of research available relating to specific recommended therapeutic approaches to paediatric burn pruritus and large variances in practice across all paediatric burn units throughout the ANZBA network.

In 2015, Dr Mahmoud El Bably (Anaesthetic Fellow) with the support of Dr Mitchell Nash (Burns Fellow) and the multidisciplinary burns team at CHW commenced development of guidelines for the treatment of post-burn pruritus in the paediatric population. These guidelines offer a treatment ladder for the pharmacological pruritic management of burns < 15% TBSA without grafting, for inpatients > 15% TBSA or post grafting and for those outpatients undergoing procedural sedation in the Burns and Plastics Treatment Centre (BPTC).

These guidelines will form part of CHWs Burn Clinical Practice Guidelines and are envisaged to become a useful tool to assist in providing the highest standard of uniform and consistent care in the prevention and management of pruritus in our paediatric burn population.

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