Pediatric Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States

Hsu, D. Y.; Brieva, J.; Silverberg, N. B.; Paller, A. S.; Silverberg, J. I.

J Am Acad Dermatol. 2017 Mar 14; 76(5):811-817 e4

Abstract

BACKGROUND: Little is known about the epidemiology of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in children. OBJECTIVE: We sought to determine the morbidity, mortality, and comorbid health conditions of SJS and TEN in US children. METHODS: This was a cross-sectional study of the 2009 to 2012 Nationwide Inpatient Sample, which contains a representative 20% sample of all US hospitalizations. Sociodemographics, inflation-adjusted cost, length of stay, comorbidities, and mortality were analyzed using descriptive statistics and multivariate regression analyses. RESULTS: The incidences of SJS, SJS-TEN, and TEN were a mean 5.3, 0.8, and 0.4 cases per million children per year in the US, respectively. Prolonged length of stay and higher costs of care (SJS: 9.4 +/- 0.6 days, $24,947 +/- $3171; SJS-TEN: 15.7 +/- 1.5 days, $63,787 +/- $8014; TEN: 20.4 +/- 6.3 days, $102,243 +/- $37,588) were observed compared with all other admissions (4.6 +/- 0.1 days, $10,496 +/- $424). Mortality was 0% for SJS, 4% for SJS-TEN, and 16% for TEN. In regression models, predictors of mortality included renal failure (adjusted OR [aOR] 300.28, 95% confidence interval [CI] 48.59->999.99), malignancy (aOR 54.33, 95% CI 9.40-314.22), septicemia (aOR 30.45, 95% CI 7.91-117.19), bacterial infection (aOR 20.38, 95% CI 5.44-76.36), and epilepsy (aOR 5.56, 95% CI 1.37-26.2). LIMITATIONS: Data regarding treatment were not available. Date of diagnosis of comorbidities was not present, precluding temporal analysis. CONCLUSIONS: Pediatric SJS/TEN poses a substantial health burden in the United States.

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