Development of a Skin-Directed Scoring System for Stevens-Johnson Syndrome and Epidermal Necrolysis: A Delphi Consensus Exercise.
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Waters Margo, Dobry Allison, Le Stephanie T, Shinkai Kanade, Beachkofsky Thomas M, Davis Mark D P, Dominguez Arturo R, Kroshinsky Daniela, Markova Alina, Micheletti Robert G, Mostaghimi Arash, Pasieka Helena B, Rosenbach Misha, Seminario-Vidal Lucia, Trinidad John, Albrecht Joerg, Altman Emily M, Arakaki Ryan, Ardern-Jones Michael, Bridges Alina G, Cardones Adela R, Chadha Angad A, Chen Jennifer K, Chen Steven T, Cheng Kyle, Daveluy Steven, DeNiro Katherine L, Harp Joanna, Keller Jesse J, King Brett, Korman Abraham M, Lowenstein Eve J, Luxenberg Erin, Mancuso Jennifer Brescoll, Mauskar Melissa M, Milam Philip, Motaparthi Kiran, Nelson Caroline A, Nguyen Cuong V, Nutan Fnu, Ortega-Loayza Alex G, Patel Tejesh, Rahnama-Moghadam Sahand, Rekhtman Sergey, Rojek Nathan W, Sarihan Mansi, Shaigany Sheila, Sharma Timmie R, Shearer Sabrina M, Shields Bridget E, Strowd Lindsay C, Tartar Danielle M, Thomas Cristina, Wanat Karolyn A, Walls Andrew C, Zaba Lisa C, Ziemer Carolyn M, Maverakis Emanual, Kaffenberger Benjamin H
Аннотация
OBJECTIVES: To establish consensus among expert dermatologists on EN terminology, morphologic progression, and most-affected sites, and to build a framework for developing a skin-directed scoring system for EN.
EVIDENCE REVIEW: A Delphi consensus using the RAND/UCLA appropriateness criteria was initiated with a core group from the Society of Dermatology Hospitalists to establish agreement on the optimal design for an EN cutaneous scoring instrument, terminology, morphologic traits, and sites of involvement.
FINDINGS: In round 1, the 54 participating dermatology hospitalists reached consensus on all 49 statements (30 appropriate, 3 inappropriate, 16 uncertain). In round 2, they agreed on another 15 statements (8 appropriate, 7 uncertain). There was consistent agreement on the need for a skin-specific instrument; on the most-often affected skin sites (head and neck, chest, upper back, ocular mucosa, oral mucosa); and that blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions comprise the morphologic traits of EN and can be consistently differentiated.
CONCLUSIONS AND RELEVANCE: This consensus exercise confirmed the need for an EN skin-directed scoring system, nomenclature, and differentiation of specific morphologic traits, and identified the sites most affected. It also established a baseline consensus for a standardized EN instrument with consistent terminology.