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. 2017 May;76(5):811-817.e4.
doi: 10.1016/j.jaad.2016.12.024. Epub 2017 Mar 9.

Pediatric Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States

Derek Y Hsu  1 , Joaquin Brieva  1 , Nanette B Silverberg  2 , Amy S Paller  3 , Jonathan I Silverberg  4
Affiliations

Pediatric Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States

Derek Y Hsu et al. J Am Acad Dermatol. 2017 May.

Abstract

Background: Little is known about the epidemiology of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in children.

Objective: We sought to determine the morbidity, mortality, and comorbid health conditions of SJS and TEN in US children.

Methods: This was a cross-sectional study of the 2009 to 2012 Nationwide Inpatient Sample, which contains a representative 20% sample of all US hospitalizations. Sociodemographics, inflation-adjusted cost, length of stay, comorbidities, and mortality were analyzed using descriptive statistics and multivariate regression analyses.

Results: The incidences of SJS, SJS-TEN, and TEN were a mean 5.3, 0.8, and 0.4 cases per million children per year in the US, respectively. Prolonged length of stay and higher costs of care (SJS: 9.4 ± 0.6 days, $24,947 ± $3171; SJS-TEN: 15.7 ± 1.5 days, $63,787 ± $8014; TEN: 20.4 ± 6.3 days, $102,243 ± $37,588) were observed compared with all other admissions (4.6 ± 0.1 days, $10,496 ± $424). Mortality was 0% for SJS, 4% for SJS-TEN, and 16% for TEN. In regression models, predictors of mortality included renal failure (adjusted OR [aOR] 300.28, 95% confidence interval [CI] 48.59->999.99), malignancy (aOR 54.33, 95% CI 9.40-314.22), septicemia (aOR 30.45, 95% CI 7.91-117.19), bacterial infection (aOR 20.38, 95% CI 5.44-76.36), and epilepsy (aOR 5.56, 95% CI 1.37-26.2).

Limitations: Data regarding treatment were not available. Date of diagnosis of comorbidities was not present, precluding temporal analysis.

Conclusions: Pediatric SJS/TEN poses a substantial health burden in the United States.

Keywords: Stevens-Johnson syndrome; burden of disease; children; epidemiology; hospitalization; pediatric; toxic epidermal necrolysis.

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Conflict of interest statement

Conflicts of interest: The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1
Figure 1
Association between SJS or SJS-TEN/TEN and health comorbidities. Survey logistic regression models were constructed with SJS or SJS-TEN/TEN as the independent variable and the respective comorbidity as the dependent variable. Odds ratios and 95% confidence intervals were estimated. Models included race/ethnicity, age and sex as covariates. Adjusted odds ratios and 95% confidence intervals were estimated. Forest-plots of the adjusted odds ratios and 95% confidence intervals are presented.
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