title: A clinicotherapeutic analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis with an emphasis on the predictive value and accuracy of SCORe of Toxic Epidermal Necrolysis.
abstract: BACKGROUND
  The SCORTEN scale (SCORe of Toxic Epidermal Necrolysis) is widely used to predict mortality in patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Although it is largely a useful tool, the predictive ability of the scale is variable, and modifications to the existing scale have been suggested. In addition, there is controversy regarding the roles of active therapy and conservative management.
  
  
  OBJECTIVE
  This study was conducted to assess outcomes in SJS/TEN patients managed conservatively and to analyze the predictive performance of SCORTEN.
  
  
  METHODS
  Sixty patients were studied prospectively from October 2008 to September 2011. The accuracy of SCORTEN in predicting mortality was analyzed on days 1, 3, and 5 of admission. All patients were managed conservatively.
  
  
  RESULTS
  The discriminative power of SCORTEN was acceptable, being best on day 5. The agreement between actual and predicted mortality was poor, as indicated by a low P-value of the Hosmer-Lemeshow statistic. Only three parameters (heart rate, blood urea, and serum bicarbonate) were found to be significant on multivariate analysis, and all of these represented components within the original SCORTEN scale. The mortality rate was 16.7%. All deaths occurred within the first two weeks (8-12 days).
  
  
  CONCLUSIONS
  Serial analysis using SCORTEN is better than analysis performed only on day 1. Although the scale is largely useful, its performance is influenced by the demographic profile of the study population; minor modifications based on the population studied may increase the predictive accuracy of the original SCORTEN. In addition, conservative management is a valid therapeutic option, is preferable to treatment with steroids and immunosuppressants, and is highly recommended.
authors.affiliation: Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
authors.forename: Shuchi
authors.initials: S
authors.lastname: Bansal
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Garg
authors.forename: Kabir
authors.initials: K
authors.lastname: Sardana
authors.forename: Rashmi
authors.initials: R
authors.lastname: Sarkar
mesh_terms: D000293:Adolescent; D000328:Adult; D001639:Bicarbonates / Q000097:blood; D002648:Child; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000401:mortality*; D013997:Time Factors; D014508:Urea / Q000097:blood; D055815:Young Adult
chemical_list: D001639:Bicarbonates; D014508:Urea