Antishear therapy for toxic epidermal necrolysis: an alternative treatment approach.
BACKGROUND
Toxic epidermal necrolysis syndrome is a devastating disease, with mortality rates ranging between 20 and 60 percent. This study evaluated an alternative treatment approach using antishear wound care and compared outcomes using the severity of illness score for toxic epidermal necrolysis syndrome (SCORTEN) system.


METHODS
Records of 48 patients with a histopathologic diagnosis of toxic epidermal necrolysis syndrome treated with burn equivalent critical care and antishear wound care from September of 1985 to April of 2004 were reviewed. Observed mortality data were compared with those expected using the SCORTEN, and the standardized mortality ratio was calculated.


RESULTS
The overall mortality rate was 27 percent. Factors affecting mortality were advancing age, time to burn unit admission, multisystem organ failure, and presence of comorbidities (p = 0.02, p = 0.02, p < 0.001, and p = 0.003, respectively). Chronic renal insufficiency and malignancy were two independent risk factors for nonsurvival (p = 0.04 and p = 0.004, respectively). Patients with a SCORTEN score of 2 or less had no mortality rate in this series. Observed and predicted mortality rates were comparable for patients with SCORTEN scores of 3 or greater. Patients with combined scores of 3 or less had a standardized mortality ratio score of 0.58 (42 percent mortality reduction). Overall, the standardized mortality ratio was 0.89 (11 percent mortality reduction).


CONCLUSIONS
Transfer to a burn intensive care unit and initiation of critical care and wound protocols similar to those used for burn patients are recommended for patients with toxic epidermal necrolysis syndrome. Antishear wound care provides an effective alternative wound care approach with equivalent mortality rates.
Dorafshar
Amir H
AH
Chicago, Ill. From the Section of Plastic and Reconstructive Surgery, Department of Surgery, and the Department of Anesthesia and Critical Care, University of Chicago.
Dickie
Sara R
SR
Cohn
Alvin B
AB
Aycock
Joyce K
JK
O'Connor
Annemarie
A
Tung
Avery
A
Gottlieb
Lawrence J
LJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002053:Burn Units; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D013262:Stevens-Johnson Syndrome / Q000209:etiology / Q000628:therapy*; D014947:Wounds and Injuries / Q000628:therapy