Richard Emily B, Hamer Diana, Musso Mandi W, Short Tracee, O'Neal Hollis R
Internal Medicine Residency Program, Louisiana State University Health Sciences Center, New Orleans.
Division of Academic Affairs, Our Lady of the Lake Regional Medical Center, Baton Rouge LA.
J Burn Care Res. 2018 Jun 13;39(4):585-592. doi: 10.1093/jbcr/irx023.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, type IV hypersensitivity reactions of the skin and mucosa. These reactions (SJS/TEN) are frequently managed in burn units; however, no standardized guidelines exist for the treatment and management of SJS/TEN. To gain insight into current SJS/TEN management practices, a survey on admission, diagnosis, and management, was conducted across accredited burn units in the United States. A 28-item question survey on SJS/TEN management, diagnosis, and treatment practices was distributed among medical directors and co-directors of American Burn Association-verified burn centers. Responses were collected over a 6-week period. In total, 31 (48% response rate) burn unit medical directors/co-directors participated in the survey. The majority of responders indicate that acceptance to their burn unit is based on clinical suspicion of SJS/TEN (74%), and biopsy or dermatological evaluation is not required (67 and 87%, respectively). More than half (61%) of the burn units have their own SJS/TEN protocol in place. No consensus was observed on different treatment aspects, such as infection control, systemic treatment, and wound care. Most directors reported their burn units to consult ophthalmology (77%) and dermatology (54%) for the management of patients with SJS/TEN. Large variability in procedures of admission, treatment, and management of SJS/TEN was identified across burn centers. This study demonstrates the urgent need for SJS/TEN standardized guidelines in the United States.
史蒂文斯 - 约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）是罕见的皮肤和黏膜IV型超敏反应。这些反应（SJS/TEN）通常在烧伤病房进行处理；然而，目前尚无针对SJS/TEN治疗和管理的标准化指南。为深入了解当前SJS/TEN的管理实践，在美国各地经认可的烧伤病房开展了一项关于入院、诊断和管理的调查。一项包含28个问题的关于SJS/TEN管理、诊断和治疗实践的调查问卷分发给了美国烧伤协会认证的烧伤中心的医疗主任和联合主任。在6周的时间内收集了回复。共有31位（回复率48%）烧伤病房医疗主任/联合主任参与了此次调查。大多数回复者表示，患者被收入其烧伤病房是基于对SJS/TEN的临床怀疑（74%），且不需要活检或皮肤科评估（分别为67%和87%）。超过一半（61%）的烧伤病房有自己的SJS/TEN治疗方案。在感染控制、全身治疗和伤口护理等不同治疗方面未达成共识。大多数主任报告称，他们的烧伤病房在管理SJS/TEN患者时会咨询眼科（77%）和皮肤科（54%）。各烧伤中心在SJS/TEN的入院、治疗和管理程序方面存在很大差异。这项研究表明美国迫切需要SJS/TEN的标准化指南。
