538 Antishear Therapy for Toxic Epidermal Necrolysis: A Follow-up Study

Abstract

Abstract Introduction Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TEN) are life-threatening dermatologic conditions, which are best approached by a multidisciplinary team practicing burn-equivalent care. There is a lack of consensus on wound management in these patients, in particular whether to debride detached epidermis. Our center instituted “antishear” wound therapy thirty-five years ago, where detached skin is left in situ as a biologic dressing. A standardized protocol aims to avoid shear forces to prevent further desquamation of involved areas. In this study, we follow-up on our outcomes with antishear therapy during the latter half of our center’s experience. Methods A retrospective chart review was conducted for all patients admitted between July 2004 – May 2020 with a Dermatologist-confirmed diagnosis of SJS/TEN. Patients admitted with non-SJS/TEN dermatologic diagnoses and those treated outside of the burn center were excluded. All patients were treated with burn-equivalent critical care and antishear wound therapy. Data was characterized by demographics, inciting agent, total body surface area (%TBSA) affected, hospital course, and any administered systemic therapy. Univariate regression was performed to identify factors that increased mortality. Standardized mortality ratios were calculated at each SCORTEN level and in aggregate. Results Of the 51 patients that met inclusion criteria, 10 (20%), 22 (43%), and 19 (37%) developed SJS (< 10% TBSA), SJS/TEN overlap (10%-30% TBSA), and TEN (>30% TBSA) respectively. Mean SCORTEN (day 3) and %TBSA were 2.6 and 28%, respectively. Overall mortality was 22%; SCORTEN (p< 0.001), %TBSA involvement (p< 0.02), and development of multi-system organ failure (p< 0.001) correlated with increased mortality. No mortality was observed for patients with a SCORTEN ≤2. Patients with SCORTEN scores of ≤3 and >3 had standardized mortality ratios of 0.63 (p=0.21) and 0.78 (p=0.17), respectively, representing 37% and 22% reductions in mortality. The standardized mortality ratio across the entire cohort was 0.73 (p=0.14), representing a 23% reduction in mortality. Conclusions Incorporating the antishear approach as part of burn-equivalent care in SJS/TENS patients is an effective alternative with equivalent mortality outcomes compared to SCORTEN predictions. Standardized mortality ratios were lower for patients with SCORTEN ≤3 and SCORTEN >3, but limited sample size reduced ability to show statistical significance.