Document Detail


Burn center care for patients with toxic epidermal necrolysis.
MedLine Citation:
PMID:  7874336     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Toxic epidermal necrolysis (TEN) is a life threatening exfoliative disorder that is most commonly precipitated by the administration of a medication. Efforts to reduce morbidity and improve survival have brought into question the use of corticosteroids and recommend the transfer of patients to a burn center to facilitate wound care. STUDY DESIGN: This study evaluated the correlation of measures of disease severity and impact of treatment strategies on morbidity and mortality in patients with TEN. The records of all patients with TEN admitted to the United States Army Institute of Surgical Research during a 12 year period were reviewed. Patient characteristics, etiologic agents, time to referral of patients to the burn center, corticosteroid therapy, and other demographic features were studied. Univariate and multivariate analyses were used to determine the significance of these factors with respect to outcome. RESULTS: The sulfonamides and phenytoin were the most frequently identified etiologic agents. Patients at the extremes of age had a higher mortality rate. The period of hospitalization was longer in patients transferred to the burn center more than seven days after skin slough. Percent of epidermalysis, white blood cell count nadir, and corticosteroid administration for more than 48 hours were independently associated with mortality. CONCLUSIONS: These data indicate that the sulfonamides and phenytoin are the most common etiologic agents, expeditious transfer to a burn center reduces morbidity, and corticosteroid administration dramatically increases mortality.
Authors:
J J Kelemen; W G Cioffi; W F McManus; A D Mason; B A Pruitt
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  180     ISSN:  1072-7515     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  1995 Mar 
Date Detail:
Created Date:  1995-03-31     Completed Date:  1995-03-31     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  273-8     Citation Subset:  AIM; IM    
Affiliation:
Department of General Surgery, Brooke Army Medical Center, Sam Houston, Texas.
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / administration & dosage,  therapeutic use
Adult
Age Factors
Bacteremia / microbiology
Bandages
Body Surface Area
Burn Units*
Child
Clinical Protocols
Drug Administration Schedule
Epidermal Necrolysis, Toxic / drug therapy,  etiology,  pathology,  therapy*
Female
Follow-Up Studies
Forecasting
Humans
Kidney Failure / physiopathology
Male
Patient Transfer
Survival Rate
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones
Comments/Corrections
Comment In:
J Am Coll Surg. 1995 Mar;180(3):340-2   [PMID:  7874346 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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