title: A systematic review of the management and outcome of toxic epidermal necrolysis treated in burns centres.
abstract: BACKGROUND
  Toxic epidermal necrolysis (TEN) is a rare condition characterised by mucocutaneous exfoliation of greater than 30% total body surface area (%TBSA), increasingly being treated in burns centres. The rate of mortality varies significantly in the literature, with recent prospective studies in non-burns centres reporting percentage mortality of approximately 45%. We undertook a systematic review of published studies that included TEN patients treated specifically in burns centres to determine a cumulative mortality rate.
  
  
  METHODS
  Electronic searches of MEDLINE, EMBASE and The Cochrane Library (Issue 4, 2010) databases from 1966 onwards were used to identify English articles related to the treatment of TEN in burns centres.
  
  
  RESULTS
  The systematic literature search identified 20 studies which specifically described patients with TEN grater than 30% %TBSA. Treatment regimens varied amongst studies, as did mortality. The overall percentage mortality of the combined populations was 30%. Risk factors commonly described as associated with mortality included age, %TBSA and delay to definitive treatment.
  
  
  CONCLUSIONS
  The review highlights the variation between principles of treatment and mortality amongst burns centres. It offers a standard that burns centre can use to internationally compare their mortality rates. The review supports the ongoing reporting of outcomes in TEN patients with epidermal detachment greater than 30%.
authors.affiliation: Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Dermatology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, School of Medicine, Faculty of Health, Deakin University, Victoria, Australia. Electronic address: dmahar@deakin.edu.au.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Mahar
authors.affiliation: Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Wasiak
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Hii
authors.affiliation: Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Central and Eastern Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
authors.forename: Heather
authors.initials: H
authors.lastname: Cleland
authors.affiliation: Department of Surgery, School of Medicine, Faculty of Health, Deakin University, Victoria, Australia.
authors.forename: David A
authors.initials: DA
authors.lastname: Watters
authors.affiliation: Department of Dermatology, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Douglas
authors.initials: D
authors.lastname: Gin
authors.affiliation: School of Medicine, Griffith University, Queensland, Australia.
authors.forename: Anneliese B
authors.initials: AB
authors.lastname: Spinks
mesh_terms: D000367:Age Factors; D001830:Body Surface Area; D002053:Burn Units; D006801:Humans; D013262:Stevens-Johnson Syndrome / Q000401:mortality / Q000628:therapy*; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Toxic epidermal necrolysis