333 A modified delphi consensus exercise: developing a skin-directed Stevens-Johnson Syndrome/toxic epidermal necrolysis scoring system

Abstract

While SCORTEN and ABCD-10 are available to provide a patient prognosis in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN), they are not intended to assess the severity, progression, or improvement in disease throughout the hospitalization. A skin-directed instrument is needed. A modified Delphi consensus using RAND/UCLA appropriateness criteria was initiated with a core group of members who have published in the topic. A two-part consensus was determined to be needed to first establish agreement on the optimal design for a cutaneous scoring instrument, terminology, morphologies, and locations of involvement. Fifty-four dermatology hospitalists agreed to participate in this study. After one round for part one, all questions and statements reached consensus. Participants consistently agreed on the need of such an instrument and that certain locations including the head and neck, chest, upper back, ocular mucosa, and oral mucosa were almost always affected by SJS/TEN. Participants also agreed on morphologic terminology and that morphologies could be differentiated into blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions. The second part of the study will establish agreement on time course, progression, and weighting assessments and is in progress. The Delphi consensus has established that there is widespread agreement among expert dermatologists that there is a need for a skin directed scoring system, widespread agreement that specific morphologies can be differentiated consistently on both cutaneous and mucosal surfaces, and that some areas of the body are almost always affected when SJS/TEN occurs. This undertaking has so far revealed best practices as well as areas of uncertainty with SJS/TEN to help develop the framework for an SJS/TEN skin-directed scoring instrument.