25691 An audit of the management and outcomes of toxic epidermal necrolysis in a specialist intensive care unit in the UK

Abstract

Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous reaction, usually secondary to drugs, which should be managed in specialist intensive care units (ICU). The British Association of Dermatologists (BAD) published UK management guidelines in 2016. This audit aims to assess how compliant our service is with the BAD standards for audit, and to measure patient outcomes. All patients admitted to Guy’s and St Thomas’ ICU (London) with a diagnosis of TEN between 2016 and 2019 were included. Data were collected retrospectively from patient records and included: SCORETEN, drug causality assessment, multidisciplinary team (MDT) involvement, length of ICU stay and survival. 14 cases were identified and included 8 males and 6 females, with a mean age of 61 years (SD ± 18.9). 78.6% of cases had SCORETEN documented on admission, of those, 45.5% had a SCORETEN of 4 to 6. Drug causality assessment was performed on admission in 100% of cases; allopurinol and sulfasalazine were the commonest culprit drugs. 92.9% of patients were reviewed by an ophthalmologist within 24 hours of admission. Oral and urogenital assessments were made on admission in 92.9% and 78.6% of cases, respectively. The average length of ICU stay was 11.9 days (SD ± 9). The rate of survival in this center was 64.3%. Mortality correlated positively with age (r = 0.6, 2-sided P = .02). Recovery rate at this center exceeded expectations, given the severity of SCORETEN. Good outcomes are attributed to compliance with the BAD standards, particularly in prompt drug causality assessment and MDT involvement.