Burn center care for patients with toxic epidermal necrolysis.
BACKGROUND
Toxic epidermal necrolysis (TEN) is a life threatening exfoliative disorder that is most commonly precipitated by the administration of a medication. Efforts to reduce morbidity and improve survival have brought into question the use of corticosteroids and recommend the transfer of patients to a burn center to facilitate wound care.


METHODS
This study evaluated the correlation of measures of disease severity and impact of treatment strategies on morbidity and mortality in patients with TEN. The records of all patients with TEN admitted to the United States Army Institute of Surgical Research during a 12 year period were reviewed. Patient characteristics, etiologic agents, time to referral of patients to the burn center, corticosteroid therapy, and other demographic features were studied. Univariate and multivariate analyses were used to determine the significance of these factors with respect to outcome.


RESULTS
The sulfonamides and phenytoin were the most frequently identified etiologic agents. Patients at the extremes of age had a higher mortality rate. The period of hospitalization was longer in patients transferred to the burn center more than seven days after skin slough. Percent of epidermalysis, white blood cell count nadir, and corticosteroid administration for more than 48 hours were independently associated with mortality.


CONCLUSIONS
These data indicate that the sulfonamides and phenytoin are the most common etiologic agents, expeditious transfer to a burn center reduces morbidity, and corticosteroid administration dramatically increases mortality.
Kelemen
J J
JJ
Department of General Surgery, Brooke Army Medical Center, Sam Houston, Texas.
Cioffi
W G
WG
McManus
W F
WF
Mason
A D
AD
Pruitt
B A
BA
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D016470:Bacteremia / Q000382:microbiology; D001458:Bandages; D001830:Body Surface Area; D002053:Burn Units; D002648:Child; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D010360:Patient Transfer; D051437:Renal Insufficiency / Q000503:physiopathology; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones