Mortality and Use of the Auxiliary Score in Extensive Toxic Epidermal Necrolysis Patients Admitted to an Adult Burns Referral Centre

Abstract

Background: Toxic epidermal necrolysis (TEN) is a rare but fatal condition characterised by cutaneous exfoliation of the dermoepidermal layer and mucosal surfaces. Extensive TEN with epidermal detachment >30% of the total body surface area has been associated with a high mortality. Objective: This study aims to evaluate factors associated with mortality in extensive TEN. In the absence of data to qualify scoring systems such as SCORTEN, this study also aims to evaluate the use of the auxiliary score as a tool for calculating expected mortality. Methods: A retrospective chart review of all patients presenting to our burns service with extensive TEN was undertaken. Application and evaluation of the auxiliary score was also undertaken for this patient population. Results: In extensive TEN, age and delay in admission to a burns centre were factors associated with mortality. Applying the auxiliary score to our patient population, there were no significant differences between expected mortality and observed mortality. Conclusion: Mortality was associated with age and delay in definitive treatment in extensive TEN. Whilst SCORTEN is the gold standard prognostic tool for patients with TEN, in the absence of SCORTEN values, the auxiliary score provides an alternative scoring system to evaluate expected mortality.

An individual patient data meta‐analysis of wound care in patients with toxic epidermal necrolysis

“…Cases with 10%-30% TBSA loss are considered to overlap, 1 where the majority of TEN cases are caused by adverse reactions to medications. [2][3][4] TEN is associated with complications including sepsis, [5][6][7] and mortality rates are reported between 14% and 30% [8][9][10] which is strongly dependent on the extent of epithelial loss. 8,9 Patients with TEN are assessed by the Severity-of-Illness Score for TEN (SCORTEN), a tool for predicting mortality.…”

“…Wound care is a focus in patients with TEN, to reduce insensible fluid losses, prevent sepsis and promote re-epithelialisation. TEN involves significant epidermal detachment, and warrants treatment in a suitable specialised unit 7,14,15 which is known to reduce mortality. [16][17][18][19] The principles of wound care include protection of the underlying exposed dermis, minimisation of infection, reducing the risk of pigment changes and scarring, optimising re-epithelialisation and prevention of insensible fluid losses.…”

“…TEN is associated with complications including sepsis, 5‐7 and mortality rates are reported between 14% and 30% 8‐10 which is strongly dependent on the extent of epithelial loss 8,9 …”

“…Wound care is a focus in patients with TEN, to reduce insensible fluid losses, prevent sepsis and promote re‐epithelialisation. TEN involves significant epidermal detachment, and warrants treatment in a suitable specialised unit 7,14,15 which is known to reduce mortality 16‐19 …”