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Intensive care needs and long‐term outcome of pediatric toxic epidermal necrolysis – A 10‐year experience
Author(s) -
Williams Vijai,
Reddy Mounika,
Bansal Arun,
Baranwal Arun K.,
Nallasamy Karthi,
Angurana Suresh K.,
Handa Sanjeev,
Ram Jagat,
Jayashree Muralidharan,
Singhi Sunit
Publication year - 2021
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.15054
Subject(s) - medicine , toxic epidermal necrolysis , pediatric intensive care unit , sepsis , pediatrics , intensive care unit , medical record , body surface area , complication , retrospective cohort study , adverse effect , surgery , dermatology
Background Toxic epidermal necrolysis (TEN) is a life‐threatening severe cutaneous adverse reaction. Data on pediatric TEN is limited. Methods Case records of 44 children, 1 month–12 years with a diagnosis of TEN (>30% body surface area [%BSA] detachment) admitted to a tertiary pediatric intensive care unit (PICU) between 2009 and 2018 were analyzed retrospectively. The primary outcome was mortality, and secondary outcomes were organ dysfunction, length of stay (LOS), and long‐term sequelae. Results Median (IQR) age was 6.5 (3.6, 8.0) years, and 25 (57%) were boys. Median (IQR) %BSA involved, SCORTEN score, and PRISM‐III were 65% (45, 80); 2 (2, 3) and 13 (10, 16), respectively. Antiepileptics ( n = 24, 54.6%) and antimicrobials ( n = 8, 18.2%) were the most common offending agents. Twenty‐four (54.5%) children had culture positive sepsis. Immunomodulatory therapy was provided in 35 (79.5%) and conservative management in nine (20.5%) children. Intravenous immunoglobulin (IVIG) was given in 22 (50%), steroids in three (6.8%), and both IVIG and steroids in 10 (22.7%) children. Respiratory failure ( n = 14, 31.8%) was the commonest organ failure. Mortality was 15.9% ( n = 7), and median (IQR) PICU‐LOS in survivors was 8 (4, 11.75) days. There was no association between IVIG, steroids, or conservative management with mortality or LOS. Ocular sequelae ( n = 20, 54.1%) were the most common long‐term complication followed by skin (18, 40.1%). Conclusion Immunomodulation with IVIG or steroids was not associated with any mortality benefit as compared to conservative management alone. Further research is required to determine the most effective treatment in pediatric TEN.