A systematic review of the management and outcome of toxic epidermal necrolysis treated in burns centres

Patrick D Mahar; Jason Wasiak; Belinda Hii; Heather Cleland; David A Watters; Douglas Gin; Anneliese B Spinks

doi:10.1016/j.burns.2014.02.006

A systematic review of the management and outcome of toxic epidermal necrolysis treated in burns centres

Burns. 2014 Nov;40(7):1245-54. doi: 10.1016/j.burns.2014.02.006. Epub 2014 Mar 27.

Authors

Patrick D Mahar¹, Jason Wasiak², Belinda Hii³, Heather Cleland⁴, David A Watters⁵, Douglas Gin⁶, Anneliese B Spinks⁷

Affiliations

¹ Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Dermatology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, School of Medicine, Faculty of Health, Deakin University, Victoria, Australia. Electronic address: dmahar@deakin.edu.au.
² Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia.
³ Department of Plastic and Reconstructive Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.
⁴ Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Central and Eastern Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
⁵ Department of Surgery, School of Medicine, Faculty of Health, Deakin University, Victoria, Australia.
⁶ Department of Dermatology, The Alfred Hospital, Melbourne, Victoria, Australia.
⁷ School of Medicine, Griffith University, Queensland, Australia.

PMID: 24685065
DOI: 10.1016/j.burns.2014.02.006

Abstract

Introduction: Toxic epidermal necrolysis (TEN) is a rare condition characterised by mucocutaneous exfoliation of greater than 30% total body surface area (%TBSA), increasingly being treated in burns centres. The rate of mortality varies significantly in the literature, with recent prospective studies in non-burns centres reporting percentage mortality of approximately 45%. We undertook a systematic review of published studies that included TEN patients treated specifically in burns centres to determine a cumulative mortality rate.

Methods: Electronic searches of MEDLINE, EMBASE and The Cochrane Library (Issue 4, 2010) databases from 1966 onwards were used to identify English articles related to the treatment of TEN in burns centres.

Results: The systematic literature search identified 20 studies which specifically described patients with TEN grater than 30% %TBSA. Treatment regimens varied amongst studies, as did mortality. The overall percentage mortality of the combined populations was 30%. Risk factors commonly described as associated with mortality included age, %TBSA and delay to definitive treatment.

Conclusion: The review highlights the variation between principles of treatment and mortality amongst burns centres. It offers a standard that burns centre can use to internationally compare their mortality rates. The review supports the ongoing reporting of outcomes in TEN patients with epidermal detachment greater than 30%.

Keywords: Toxic epidermal necrolysis.

Publication types

Review
Systematic Review

MeSH terms

Age Factors
Body Surface Area
Burn Units*
Humans
Stevens-Johnson Syndrome / mortality
Stevens-Johnson Syndrome / therapy*
Time-to-Treatment*
Treatment Outcome