Pediatric toxic epidermal necrolysis: using SCORTEN and predictive models to predict morbidity when a focus on mortality is not enough.

Toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS) are rare yet severe exfoliative skin disorders. The authors examined the efficacy of predictive models for their use as prognostic indicators in pediatric SJS or TEN. Over a 15-year period, 41 patients ≤18 years of age were identified and reviewed. Predictive models compared retrospectively to the observed mortality in the population included: SCORTEN (Score of Toxic Epidermal Necrolysis), Pediatric Index of Mortality 2, Pediatric Risk of Mortality III-24, and Abbreviated Burn Severity Index. Correlation coefficients and 95% confidence intervals were calculated for the following: acute hospital length of stay, days until wound closure, days of mechanical ventilation, number of infectious complications, and number of acute operative procedures. When calculated within the first 24 hours of admission, the four models predicted low rates of mortality, approaching our 0% observed mortality, and also demonstrated a significant correlation between higher scores and the five chosen indicators of morbidity (P < .05). SCORTEN on day 3 of admission was statistically significant (P < .05) only when predicting the number of infectious complications and days of mechanical ventilation and was therefore felt to be less predictive than use of SCORTEN on admission. When calculated within the first day of admission of pediatric SJS or TEN patients, SCORTEN, Abbreviated Burn Severity Index, Pediatric Index of Mortality 2, and Pediatric Risk of Mortality III all significantly predict acute morbidity. This is the first time scoring systems have been assessed for their ability to predict mortality and morbidity in pediatric SJS or TEN despite its widely recognized, severe acute course of disease.