Analysis of treatment pathways and long-term prevalence of pruritus after burn - An observational study with real-world data.

Abstract

Burns heal with long-lasting scars and complications, such as persistent pruritus. To date, there is no consensus on optimal treatment. This study aims to identify prevalence and treatment patterns of burn-related pruritus using a large dataset. A retrospective cohort study was conducted using the real-world database TriNetX. Burn patients were identified and stratified into three cohorts by extent of total body surface area (TBSA) burned: Cohort 1 (<20 %; mild), Cohort 2 (20-39 %; moderate), and Cohort 3 (≥40 %; severe). Prevalence of pruritus, eosinophilia status, and treatment patterns were assessed. Age group and temporal effects were tested using Chi-square. We identified 257,360 burn patients with a mean age of 37 ± 23 years. Pruritus prevalence ranged from 3.29 % to 7.95 % in paediatric patients and from 1.50 % to 9.75 % in adult patients. Peak prevalence occurred in those with 20-39 % TBSA burned, aged 41-60 years, and within 3 years after burn. Severe eosinophilia peaked in 41-60-year-olds with burns > 40 % of TBSA. The most commonly prescribed drug classes across all cohorts were H1-antihistamines, 5-HT3 receptor antagonists, and neuropathic pain drugs. Our real-world database analysis indicates that the prevalence of post-burn pruritus varies by age and burn size, showing a tendency to decrease with age but increase over time. The highest prevalence was observed in patients with moderate-sized burns (20-39 % TBSA burned). Treatment patterns remain inconsistent, underscoring the need for standardized and evidence-based strategies.