Comparative outcomes of burn-specific vs. medical intensive care in stevens-johnson syndrome/toxic epidermal necrolysis: A single-center retrospective cohort study
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Presented at: Society for Investigative Dermatology 2025
Date: 2025-05-07 00:00:00
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Summary: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening, associated with up to 50% mortality rate and survivors often endure chronic morbidities. Despite their severity, data on mortality predictors, and the efficacy of both pharmacological and non-pharmacological protocols. This single-center retrospective study compared outcomes in patients receiving >90% of hospital care in burn-specific care units (BSC) vs. medical intensive care units (MIC).The cohort included 74 patients, diagnosed with SJS/TEN by a dermatologist, 30 in BSC group and 44 in MIC group between January 1, 2009, and December 31, 2018. 42% were female, with mean age of 50.1 years (SD=19.5). Patients were matched for age, sex, HIV, dialysis status, and malignancy. No significant differences were found in direct admissions vs. transferred admissions (83.3% vs. 68.2%, p=0.18), time-to-transfer (2.6 vs. 3.3 days, p=0.27), disease severity (BSA necrosis: 28.3% vs. 32.5%, p=0.47; SCORTEN: 2.09 vs. 2.17, p=0.79). Systemic corticosteroid use was higher in MIC group compared to BSC group (79.5% vs. 50%, p =0.01); no significant differences were observed in the use of IVIg (34.1% vs. 50%, p = 0.23) or cyclosporine (2.3% vs. 10%, p = 0.29). Hospital-acquired infections (50% vs. 43.3%, p=0.64), length of stay (10.9 vs. 15.9 days, p=0.15), and in-hospital mortality (18.2% vs. 20%, p=1.0) were similar. This study underscores the importance of institutional expertise and protocols, established referral systems, and intensive management strategy with multidisciplinary management over care location in optimizing outcomes for patients battling SJS/TEN. Archana Samynathan<sup>1, 5</sup>, Karl Saardi<sup>2</sup>, Emily Kim<sup>4</sup>, laura Johnson<sup>3</sup>, Jeffry J. Shupp<sup>3</sup>, Emil Oweis<sup>5</sup>, Helena Pasieka<sup>1, 5</sup> 1. Dermatology, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, MD, United States. 2. George Washington University Medical Faculty Associates, Washington, DC, United States. 3. Burn Center, MedStar Washington Hospital Center, Washington, DC, United States. 4. Georgetown University School of Medicine, Washington, DC, United States. 5. Dermatology, MedStar Washington Hospital Center, Washington, DC, United States. Clinical Research: Epidemiology and Observational Research