91 Mortality Difference in Skin Sloughing Disorders Compared to Burns in a Tertiary Care Burn Center

Abstract

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) are systemic diseases characterized by cutaneous and mucosal sloughing and complicated by multi-system organ failure and increased mortality. Early transfer to a burn center is paramount to survival. Many patients with rashes of unknown significance are transferred to burn centers for concern of having SJS or TEN. In order to optimize care for these patients, we critically evaluated our management of skin sloughing disorders, looking at the demographics and mortality compared to burn patients admitted from 2007 to 2016. Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. Adult patients admitted with burn injury and/or skin-sloughing disorders between January 1, 2007 and December 31, 2016 were eligible for inclusion. Demographics, length of stay (LOS), hospital cost, and mortality were evaluated. Five hundred ninety-six patients were admitted to our burn center with skin sloughing disorders. The average age was 48 years of age compared to 32 years of age for burns. Fifty-eight percent of the skin sloughing patients were female. The average hospital cost incurred for skin sloughing patients was $97,714, compared to $58,913 for burns. Patients with skin sloughing disorders had an average length of stay in the intensive care unit of 13 days, compared to 9 days for burn patients. The average overall length of stay was 15 days for patients with skin sloughing disorders compared to 11 days for burn patients. Skin sloughing disorder patients had a mortality of 11% compared to 2% for burns. Despite advances in critical care and management algorithms for skin sloughing disorders, this patient population continues to have increased morbidity and mortality compared to burn patients, even at a tertiary care burn center. Further study is warranted to investigate the potential proteomic and genomic changes in these patients that may lead to these outcome disparities.