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Toxic Epidermal Necrolysis Syndrome and SCORTEN – The Ohio State University Medical Center Experience
Sumita Saha MD, Brian Porshinsky MD, Rebecca Coffey CNP, Sidney F. Miller,MD
The Ohio State University Medical Center, Columbus, Ohio
2010-03-26
Presenter: Sumita Saha, MD
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: General Reconstruction
Toxic epidermal necrolysis syndrome (TENS) is a rare, life-threatening disease of mucocutaneous desquamation often resulting from adverse drug reaction. SCORTEN is a severity-of-illness score that was developed to predict the mortality of patients affected with TENS within the first 24 hours of presentation. The purpose of this study is to retrospectively review the outcomes; particularly mortality, of patients with TENS/SJS treated at OSUMC, and compare them to those expected according to SCORTEN predictions. The overall mortality of patients diagnosed with TENS/SJS was 23.8% (n=21). The SCORTEN equation was indeed predictive of mortality (r = 0.585) in patients diagnosed with TENS/SJS. Those patients managed by the burn service were found to have significantly greater epidermal detachment (p = 0.022), however, TENS/SJS patients treated by the burn service had no significant difference in length of stay or mortality (33% vs. 20%), and actually had a significantly decreased length of ICU stay (mean 6d vs. 15.8d, p = 0.029). The accuracy of the SCORTEN mortality predictors was validated in patients with TENS/SJS treated at OSUMC. Despite establishment of the OSU Burn Center in February 2006, the majority of patients with TENS/SJS are being managed by various medical services. The patients treated by the burn service had significantly greater epidermal detachment. Despite this, patients treated by the burn service had no difference in length of stay or mortality, and actually had a shorter ICU stay. These results reconfirm the benefits of involvement of the burn service in the care of patients with TENS/SJS.
