26 Mar Pediatric Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in the US
MedicalResearch.com Interview with:
Dr. Jonathan Silverberg
Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois
MedicalResearch.com: What is the background for this study?
Response: Stevens-Johnson syndrome and Toxic Epidermal Necrolysis (SJS/TEN) are relatively rare and potentially life-threatening disorders. There have been some recent advances in our understanding of the epidemiology and risk factors of SJS/TEN in adults.
However, little is known about the epidemiology of pediatric SJS/TEN.
MedicalResearch.com: What are the main findings?
Response: The incidences of SJS, SJS-TEN and TEN were a mean 5.3, 0.8, and 0.4 cases per million children per year, respectively. These incidences are similar to prior estimates of pediatric SJS-TEN. However, they are considerably lower than previous incidence estimates of adult SJS-TEN. Childhood SJS, SJS-TEN, and TEN caused a significant healthcare burden, with a mean cost of hospitalization of >$20,000, >$50,000 and >$100,000, respectively, and a total 4-year cost of $63,001,951 (mean $16.3 million per year). Children with SJS-TEN also had up to a 4-fold longer duration and 9-fold higher mean cost of hospitalization in comparison to other pediatric admissions. Mortality was 0% for SJS, 4% for SJS/TEN, and 16% for TEN, suggesting that increasing body surface area of involvement may be a mortality risk factor in children. Other major predictors of mortality in pediatric SJS/TEN, included renal failure (>300 fold odds), malignancy (>50-fold odds), septicemia (>30-fold odds), bacterial infection (>20-fold odds), and epilepsy (>50-fold odds).
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: This study suggests that renal failure, septicemia, bacterial infections, and body surface area of involvement >30% — not just >10% — are mortality risk factors in pediatric SJS/TEN. Recognizing these risk factors may be useful for prognostication.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future research is needed to determine optimal strategies aimed at reducing the incidence and mortality of pediatric SJS/Ten.
No relevant disclosures for this research.
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Citation:
J Am Acad Dermatol. 2017 Mar 9. pii: S0190-9622(16)31285-3. doi: 10.1016/j.jaad.2016.12.024. [Epub ahead of print]
Pediatric Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States.
Hsu DY1, Brieva J1, Silverberg NB2, Paller AS3, Silverberg JI
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Last Updated on March 26, 2017 by Marie Benz MD FAAD