Moreau Jacqueline F, Watson Robert S, Hartman Mary E, Linde-Zwirble Walter T, Ferris Laura K
School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; The CRISMA Center (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Pediatr Dermatol. 2014 Mar-Apr;31(2):163-8. doi: 10.1111/pde.12158. Epub 2013 May 16.
The objective of the current study was to characterize the epidemiology and resource use of U.S. children hospitalized with ophthalmologic disease secondary to erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). We studied children ages 5 to 19 years hospitalized in 2005 in 11 states, encompassing 38% of the U.S. pediatric population. Using International Classification of Diseases, Ninth Revision, Clinical Modification codes, we identified admissions of children with EM, SJS, or TEN and the presence of concurrent ophthalmologic disease, analyzed patient and hospitalization characteristics, and generated age- and sex-adjusted national estimates. We identified 460 children admitted with EM, SJS, or TEN, corresponding to 1,229 U.S. hospitalizations in 2005. Of the children with EM, SJS, or TEN, 60 (13.0%) had ophthalmologic disease, primarily (90.0%) disorders of the conjunctiva. Children with the highest proportions of ophthalmologic disease included those with mycoplasma pneumonia (26.7%), herpes simplex virus (15.6%), upper respiratory infection (13.9%), and lower respiratory infection (13.7%). Individuals with EM, SJS, or TEN and ophthalmologic disease were more likely than those without ophthalmologic disease to receive intensive care unit care (28.3% vs 17.0%, p = 0.03) and to be admitted to a children's hospital (63.3% vs 48.8%, p = 0.03). Ophthalmologic disease was also associated with a significantly longer median length of stay (6.0 days, interquartile range [IQR] 3-9 days vs 3.0 days, IQR 2-6 days, p < 0.001) and median hospital cost ($7,868, IQR $3,539-$17,440 vs $2,969, IQR $1,603-$8,656, p < 0.001). In children with EM, SJS, or TEN, ophthalmologic disease was most common in those with concurrent Mycoplasma pneumoniae and herpes simplex virus infections. Ophthalmologic disease was associated with considerably higher inpatient resource use in this population. Children with EM, SJS, or TEN should be screened and treated early for ophthalmologic disease to prevent morbidity and minimize long-term sequellae.
本研究的目的是描述因多形红斑（EM）、史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）继发眼科疾病而住院的美国儿童的流行病学特征和资源利用情况。我们研究了2005年在11个州住院的5至19岁儿童，这些州的人口占美国儿科人口的38%。使用《国际疾病分类》第九版临床修订本编码，我们确定了患有EM、SJS或TEN且并发眼科疾病的儿童的入院情况，分析了患者和住院特征，并生成了按年龄和性别调整的全国估计数。我们确定了460名因EM、SJS或TEN入院的儿童，相当于2005年美国的1229次住院。在患有EM、SJS或TEN的儿童中，60名（13.0%）患有眼科疾病，主要是（90.0%）结膜疾病。眼科疾病比例最高的儿童包括患有支原体肺炎（26.7%）、单纯疱疹病毒（15.6%）、上呼吸道感染（13.9%）和下呼吸道感染（13.7%）的儿童。患有EM、SJS或TEN且有眼科疾病的个体比没有眼科疾病的个体更有可能接受重症监护病房护理（28.3%对17.0%，p = 0.03）并入住儿童医院（63.3%对48.8%，p = 0.03）。眼科疾病还与显著更长的中位住院时间相关（6.0天，四分位间距[IQR] 3 - 9天对3.0天，IQR 2 - 6天，p < 0.001）和中位住院费用相关（7868美元，IQR 3539 - 17440美元对2969美元，IQR 1603 - 8656美元，p < 0.001）。在患有EM、SJS或TEN的儿童中，眼科疾病在并发支原体肺炎和单纯疱疹病毒感染的儿童中最为常见。眼科疾病与该人群中相当高的住院资源利用相关。患有EM、SJS或TEN的儿童应尽早接受眼科疾病筛查和治疗，以预防发病并尽量减少长期后遗症。
