The Outcomes of SJS/TEN: A Nationwide Analysis

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) syndrome are potentially fatal skin conditions frequently cared for in burn units. In a national database study, we studied the demographics and outcomes of this patient population. This retrospective cohort study included patient admissions for SJS/TEN. Patient demographics and outcomes were compared and adjusted for age, sex, inhalation injury, and percent total body surface area (TBSA). Logistical regression was used for binary outcomes, and linear regression was used for continuous outcomes. All outcomes were described in reference to the entire disease continuum (SJS/TEN) and each specific disease subcohort (SJS, SJS-TEN overlap, and TEN). Of 271 971 patients queried within the Noncommercial Burn Research Dataset, 2416 patients had a diagnosis of SJS/TEN. These patients were statistically more likely to be older (48 ± 22 years vs 36 ± 22 years), housed (1% vs 2%), females (57% vs 34%), and have a higher mean TBSA (8 ± 13% vs 7 ± 12%). In multivariable analysis, SJS/TEN was associated with increased risk of unplanned intubations (odds ratio [OR] 1.69) and pneumonia (OR 1.26), but not respiratory failure (OR 0.36). There was also an increased risk for sepsis (OR 1.43). Patients were significantly more likely to have a shorter hospital LOS (OR -3.7). There was no significant difference in mortality. In subcohort analysis, a stepwise increase in morbidity and mortality was observed when comparing SJS, SJS-TEN overlap, and TEN. Stevens-Johnson syndrome/TEN is a rare but extremely morbid disease continuum that frequently affects female patients and results in increased respiratory and alternative complications.