title: Pediatric Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States.
abstract: BACKGROUND
  Little is known about the epidemiology of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in children.
  
  
  OBJECTIVE
  We sought to determine the morbidity, mortality, and comorbid health conditions of SJS and TEN in US children.
  
  
  METHODS
  This was a cross-sectional study of the 2009 to 2012 Nationwide Inpatient Sample, which contains a representative 20% sample of all US hospitalizations. Sociodemographics, inflation-adjusted cost, length of stay, comorbidities, and mortality were analyzed using descriptive statistics and multivariate regression analyses.
  
  
  RESULTS
  The incidences of SJS, SJS-TEN, and TEN were a mean 5.3, 0.8, and 0.4 cases per million children per year in the US, respectively. Prolonged length of stay and higher costs of care (SJS: 9.4 ± 0.6 days, $24,947 ± $3171; SJS-TEN: 15.7 ± 1.5 days, $63,787 ± $8014; TEN: 20.4 ± 6.3 days, $102,243 ± $37,588) were observed compared with all other admissions (4.6 ± 0.1 days, $10,496 ± $424). Mortality was 0% for SJS, 4% for SJS-TEN, and 16% for TEN. In regression models, predictors of mortality included renal failure (adjusted OR [aOR] 300.28, 95% confidence interval [CI] 48.59->999.99), malignancy (aOR 54.33, 95% CI 9.40-314.22), septicemia (aOR 30.45, 95% CI 7.91-117.19), bacterial infection (aOR 20.38, 95% CI 5.44-76.36), and epilepsy (aOR 5.56, 95% CI 1.37-26.2).
  
  
  CONCLUSIONS
  Data regarding treatment were not available. Date of diagnosis of comorbidities was not present, precluding temporal analysis.
  
  
  CONCLUSIONS
  Pediatric SJS/TEN poses a substantial health burden in the United States.
authors.affiliation: Department of Dermatology, Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Derek Y
authors.initials: DY
authors.lastname: Hsu
authors.affiliation: Department of Dermatology, Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Brieva
authors.affiliation: Department of Dermatology, Mount-Sinai Icahn School of Medicine, New York, New York.
authors.forename: Nanette B
authors.initials: NB
authors.lastname: Silverberg
authors.affiliation: Department of Dermatology, Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Dermatology, and Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Paller
authors.affiliation: Department of Dermatology, Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: JonathanISilverberg@gmail.com.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Silverberg
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000453:epidemiology*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D009369:Neoplasms / Q000453:epidemiology*; D051437:Renal Insufficiency / Q000453:epidemiology*; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D013262:Stevens-Johnson Syndrome / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D014481:United States / Q000453:epidemiology
keywords: Stevens-Johnson syndrome; burden of disease; children; epidemiology; hospitalization; pediatric; toxic epidermal necrolysis