A Retrospective Cohort Study of the Management and Outcomes of Children Hospitalized With Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis

Publication date: Available online 30 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): James W. Antoon, Jennifer L. Goldman, Samir S. Shah, Brian Lee
BackgroundSevere cutaneous adverse reactions are rare yet life threatening conditions. The current management and outcomes of these conditions in U.S. children is unclear.ObjectivesTo characterize the current management and outcomes of Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) across U.S. children's hospitals.MethodsWe performed a retrospective cohort study of children less than 18 years of age hospitalized with a primary diagnosis of SJS or TEN at 47 U.S. freestanding children's hospitals. We compared treatment (IVIG, steroids, antibiotics, other) and outcomes (length of stay, hospital mortality, readmission, recurrence, related complications, and adjusted hospital costs) across hospitals and by SJS versus TEN diagnoses.ResultsWe identified 898 pediatric patients hospitalized with a primary diagnosis of SJS or TEN. Of these patients, 167 (18.6%) were prescribed steroids only, 229 (25.5%) IVIG only, 153 (17.04%) both IVIG and steroids. Median length of stay was 8 days (IQR5, 13) with median hospital adjusted costs of $16,265. Readmissions were common, with 88 (9.9%) of patients readmitted within 30 days of discharge and a recurrence rate of 2.7%. Overall hospital mortality in children was low at 0.56%. TEN was associated with higher mortality (3.23%) compared to SJS (0.13%). There was no association between the use of IVIG, systemic steroids, or IVIG + steroids use during the first two days of hospitalization and decreased LOS or mechanical ventilation. Complex chronic conditions and TEN diagnoses were associated with increased LOS and increased odds of mechanical ventilation.ConclusionsSurvival in children with SJS and TEN is significantly better than observed in adults. However, there is variability in the management and outcomes in children diagnosed with these severe cutaneous reactions. Further studies are needed to determine the most effective treatment strategies given the extent of health care utilization and high rate of readmissions observed in this population.