501 Burn Center Referral of Patients with Suspected Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)

Abstract

Abstract Introduction Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but potentially life-threatening, as such referral of these patients to a burn center is appropriate. However, patients with suspected SJS/TEN are often referred to the Burn Center and are found to not actually be suffering from the disease process in question. This inefficient referral process warrants further examination to identify pre-arrival those patients who are appropriate for transfer. Methods As an approved PI project we examined the records of all patients referred to our Burn Center for suspicion of SJS/TEN for the time period 2016–2018. We analyzed the corresponding data to in an attempt to more effectively identify patients with SJS/TEN and prevent unnecessary Burn Center transfers. Results Of 84 patients referred for suspected SJS/TEN 32 received confirmatory diagnosis with skin biopsy after transfer (38%). The average length of stay was 8 ICU days and 14 hospital days versus 3.6 and 9.6 days, respectively, for patients with a negative diagnosis. The mortality rate of SJS/TEN patients was 12.5% (4/32). In addition to SJS/TEN, a wide range of skin conditions were identified among referred patients, many of whom also required hospitalization, including BICU care. The various diagnoses included: Drug eruptions (14%), psoriasis (6%), dermatitis (6%), erythema multiforme (2%), lupus erythematosus (2%) and generalized exanthematous pustulosis (2%). The remainder of patients had miscellaneous or nonspecific conditions (28%). Conclusions SJS/TEN is a potentially life threatening disease often requiring hospitalization in a Burn Intensive Care Unit (BICU). However, many other disease processes have similar presentations and may also be appropriate for Burn Unit care. Without a confirmatory skin biopsy prior to referral a large number of patients are transferred to the BICU unnecessarily. Applicability of Research to Practice In the absence of skin biopsy capabilities at the referring facility an algorithm using common characteristics of actual SJS/TEN patients may improve the accuracy of pre-referral diagnosis. Additionally, this data underscores the importance of dermatology support to the Burn Unit in diagnosing and treating desquamating skin disorders.