To review the current evidence on therapeutic agents for burns pruritus and use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) classification to propose therapeutic protocols for adult and paediatric patients. All published interventions for burns pruritus were analysed by a multidisciplinary panel of burns specialists following the GRADE classification to rate individual agents. Following the collation of results and panel discussion, consensus protocols are presented. Twenty-three studies appraising therapeutic agents in the burns literature were identified. The majority of these studies (16 out of 23) are of an observational nature, making an evidence-based approach to defining optimal therapy not feasible. Our multidisciplinary approach employing the GRADE classification recommends the use of antihistamines (cetirizine and cimetidine) and gabapentin as the first-line pharmacological agents for both adult and paediatric patients. Ondansetron and loratadine are the second-line medications in our protocols. We additionally recommend a variety of non-pharmacological adjuncts for the perusal of clinicians in order to maximise symptomatic relief in patients troubled with postburn itch. Most studies in the subject area lack sufficient statistical power to dictate a ‘gold standard’ treatment agent for burns itch. We encourage clinicians to employ the GRADE system in order to delineate the most appropriate therapeutic approach for burns pruritus until further research elucidates the most efficacious interventions. This widely adopted classification empowers burns clinicians to tailor therapeutic regimens according to current evidence, patient values, risks and resource considerations in different medical environments.

To review the current evidence on therapeutic agents for burns pruritus and use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) classification to propose therapeutic protocols for adult and paediatric patients. All published interventions for burns pruritus were analysed by a multidisciplinary panel of burns specialists following the GRADE classification to rate individual agents. Following the collation of results and panel discussion, consensus protocols are presented. Twenty-three studies appraising therapeutic agents in the burns literature were identified. The majority of these studies (16 out of 23) are of an observational nature, making an evidence-based approach to defining optimal therapy not feasible. Our multidisciplinary approach employing the GRADE classification recommends the use of antihistamines (cetirizine and cimetidine) and gabapentin as the first-line pharmacological agents for both adult and paediatric patients. Ondansetron and loratadine are the second-line medications in our protocols. We additionally recommend a variety of non-pharmacological adjuncts for the perusal of clinicians in order to maximise symptomatic relief in patients troubled with postburn itch. Most studies in the subject area lack sufficient statistical power to dictate a ‘gold standard’ treatment agent for burns itch. We encourage clinicians to employ the GRADE system in order to delineate the most appropriate therapeutic approach for burns pruritus until further research elucidates the most efficacious interventions. This widely adopted classification empowers burns clinicians to tailor therapeutic regimens according to current evidence, patient values, risks and resource considerations in different medical environments.

Study design: Restrospective study of mobility of the spine. Objectives: To study the relation between mobility of the spine, operation and length of surgical stabilisation. Setting: The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. Method: Questionnaires were sent to 99 consecutive acute traumatic spinal cord-injured patients (UK residents) admitted in 1990-1994. All had acute spinal surgery. A total of 68 responded. Their replies, medical records and radiographs were reviewed. Results: (1) In all, 63 patients had surgery in the cervical, thoracolumbar or lumbar spine; 11 of them had more than two functional spinal units (FSUs) stabilised, 10 of these 11 (91%) had less than satisfactory results in terms of metal failure, improper placement of the implant or functional restriction of spinal mobility (FROSM). A total of 35 had 1-2 FSUs stabilised. None of them had metal failure or improper placement of implant, but 14 (40%) had less than satisfactory result due to FROSM; 17 had laminectomy alone, four of these had FROSM. (2) Five patients had surgery in the thoracic spine. Three of these who had 5-7 FSUs stabilised had no FROSM. Two had laminectomy alone, one of whom had FROSM. Conclusion: (1) Long surgical stabilisation in the cervical, thoracolumbar and lumbar spines was likely to result in either metal failure or FROSM. (2) Long surgical stabilisation of the thoracic spine was not associated with either metal failure or FROSM. (3) A small proportion of patients had laminectomy alone. One of them who had multiple injuries had FROSM.