Hennepin County Medical Center, Minneapolis, Minnesota.
J Burn Care Res. 2020 Sep 23;41(5):945-950. doi: 10.1093/jbcr/iraa082.
Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and Stevens-Johnson/TEN overlap syndrome (SJS/TEN) are severe exfoliative skin disorders resulting primarily from allergic drug reactions and sometimes from viral causes. Because of the significant epidermal loss in many of these patients, many of them end up receiving treatment at a burn center for expertise in the care of large wounds. Previous work on the treatment of this disease focused only on the differences in care of the same patients treated at nonburn centers and then transferred to burn centers. We wanted to explore whether patients had any differences in care or outcomes when they received definitive treatment at burn centers and nonburn centers. We queried the National Inpatient Sample database from 2016 for patients with SJS, SJS/TEN, and TEN diagnoses. We considered burn centers as those with greater than 10 burn transfers to their center and fewer than 5 burn transfers out of their center in a year. Multivariable logistic regression assessed factors associated with treatment at a burn center and mortality. Using the National Inpatient Sample, a total of 1164 patients were identified. These were divided into two groups, nonburn centers vs burn centers, and those groups were compared for demographic characteristics as well as variables in their hospital course and outcome. Patients treated at nonburn centers were more likely to have SJS and patients treated at burn centers were more likely to have both SJS/TEN and TEN. Demographics were similar between treatment locations, though African-Americans were more likely to be treated at a burn center. Burn centers had higher rates of patients with extreme severity and mortality risks and a longer length of stay. However, burn centers had similar actual mortality compared to nonburn centers. Patients treated at burn centers had higher charges and were more likely to be transferred to long-term care after their hospital stay. The majority of patients with exfoliative skin disorders are still treated at nonburn centers. Patients with SJS/TEN and TEN were more likely to be treated at a burn center. Patients treated at burn centers appear to have more severe disease but similar mortality to those treated at nonburn centers. Further study is needed to determine whether patients with these disorders do indeed benefit from transfer to a burn center.
史蒂文斯-约翰逊综合征（SJS）、中毒性表皮坏死松解症（TEN）和史蒂文斯-约翰逊/中毒性表皮坏死松解症重叠综合征（SJS/TEN）是主要由过敏药物反应引起的严重剥脱性皮肤疾病，有时也由病毒引起。由于许多患者的表皮大量脱落，他们中的许多人最终在烧伤中心接受治疗，以获得对大面积伤口护理的专业知识。以前关于这种疾病的治疗研究仅集中在对在非烧伤中心接受治疗然后转至烧伤中心的同一患者的护理差异上。我们想探讨当患者在烧伤中心和非烧伤中心接受确定性治疗时，他们的护理或结局是否存在差异。我们从 2016 年的国家住院患者样本数据库中查询了 SJS、SJS/TEN 和 TEN 诊断的患者。我们将烧伤中心定义为每年转至该中心的烧伤患者大于 10 人，而转出该中心的烧伤患者少于 5 人。多变量逻辑回归评估了与烧伤中心治疗和死亡率相关的因素。利用国家住院患者样本，共确定了 1164 名患者。将这些患者分为两组，非烧伤中心与烧伤中心，并对两组患者的人口统计学特征以及他们的住院过程和结局中的变量进行了比较。在非烧伤中心接受治疗的患者更有可能患有 SJS，而在烧伤中心接受治疗的患者更有可能患有 SJS/TEN 和 TEN。治疗地点之间的人口统计学特征相似，但非裔美国人更有可能在烧伤中心接受治疗。烧伤中心的极端严重程度和死亡率风险较高，住院时间较长。然而，烧伤中心的实际死亡率与非烧伤中心相似。烧伤中心的患者费用更高，住院后更有可能转至长期护理机构。大多数患有剥脱性皮肤疾病的患者仍在非烧伤中心接受治疗。SJS/TEN 和 TEN 患者更有可能在烧伤中心接受治疗。烧伤中心治疗的患者似乎病情更严重，但与非烧伤中心治疗的患者死亡率相似。需要进一步研究以确定这些疾病患者是否确实受益于转至烧伤中心。
