Play and heal: Randomized controlled trial of Ditto™ intervention efficacy on improving re-epithelialization in pediatric burns

Abstract

Background: The relationships between pain, stress and anxiety, and their effect on burn wound re-epithelialization have not been well explored to-date. The aim of this study was to investigate the effect of the Ditto™ (a hand-held electronic medical device providing procedural preparation and distraction) intervention on re-epithelialization rates in acute pediatric burns. Methods/Design: From August 2011 to August 2012, children (4–12 years) with an acute burn presenting to the Royal Children's Hospital, Brisbane, Australia fulfilled the study requirements and were randomized to [1] Ditto™ intervention or [2] standard practice. Burn re-epithelialization, pain intensity, anxiety and stress measures were obtained at every dressing change until complete wound re-epithelialization. Results: One hundred and seventeen children were randomized and 75 children were analyzed (n = 40 standard group; n = 35 Ditto™ group). Inability to predict wound management resulted in 42 participants no longer meeting the eligibility criteria. Wounds in the Ditto™ intervention group re-epithelialized faster than the standard practice group (−2.14 days (CI: −4.38 to 0.10), p-value = 0.061), and significantly faster when analyses were adjusted for mean burn depth (−2.26 days (CI: −4.48 to −0.04), p-value = 0.046). Following procedural preparation at the first change of dressing, the Ditto™ group reported lower pain intensity scores (−0.64 (CI: −1.28, 0.01) p = 0.052) and lower anxiety ratings (−1.79 (CI: −3.59, 0.01) p = 0.051). At the second and third dressing removals average pain (FPS-R and FLACC) and anxiety scores (VAS-A) were at least one point lower when Ditto™ intervention was received. Conclusions: The Ditto™ procedural preparation and distraction device is a useful tool alongside pharmacological intervention to improve the rate of burn re-epithelialization and manage pain and anxiety during burn wound care procedures.