A 10-Year Retrospective Cohort Study of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis at the Royal Brisbane and Women's Hospital.

BACKGROUND/

OBJECTIVES

The Royal Brisbane & Women's Hospital (RBWH) in Queensland, Australia provides definitive care for all diagnosed adult patients with SJS/TEN within its catchment. In this retrospective cohort study, we identified all SJS/TEN cases at RBWH over a 10-year period. We assessed disease incidence and the relationship of 3 variables (disease severity, time taken to admission to the definitive tertiary centre and systemic immunosuppressive treatment) to the outcome of mortality.

METHODS

Patients were identified via ICU MetaVision dermatology entries, discharge coding and manual admission recording. Age, gender, culprit drug, time to definitive tertiary centre admission, total body surface area (TBSA), SCORTEN, complications, systemic therapy utilisation and mortality were recorded. Relationships between variables were analysed using Spearman's Rank correlations and logistic regression.

RESULTS

Fifty-two cases over 10 years met inclusion criteria (37 TEN, 8 SJS/TEN and 7 SJS). Mortality (9.6%; 5 deaths) was low compared to published rates. Multivariate regression analysis revealed a significant relationship between increased SCORTEN and mortality as expected. There was no significant relationship between systemic treatment and mortality or between 'days to definitive care' and mortality. Modelling accounted for 44% of variance in mortality.

CONCLUSIONS

SJS/TEN incidence matched published rates. Severity of SJS/TEN and mortality were correlated. Neither systemic immune suppression nor time taken to be admitted to the definitive tertiary centre correlated with mortality. Expert multidisciplinary care in the RBWH ICU and Burns Unit is likely to contribute to the excellent mortality outcomes found. Limitations of the study included its retrospective cohort design, that it was performed in a single centre, and the relatively small sample size leading to statistically insignificant findings. Our results should bolster growing data to improve understanding of this rare but serious condition.