Inpatient management of epidermolysis bullosa: Consensus-based hands-on instructions for neonates and postneonates

Abstract

Background: Epidermolysis bullosa (EB), characterized by skin fragility and blistering, often requires hospitalization. Training for inpatient management of EB is limited, with no unified recommendations available in North America.

Objective: To develop consensus-derived best practices for hands-on inpatient management of EB in both the neonatal and postneonatal period.

Methods: A modified Delphi method (expert-based input via 2 surveys and a final review) was implemented. Available guidelines from EB Clinical Research Consortium centers were analyzed to determine areas of focus and formulate statements to be voted on by EB Clinical Research Consortium members, experienced EB nurses, and select family members. Study participants evaluated statements using a Likert scale: statements with at least 70% agreement were accepted; statements with 30% or more disagreement were rejected.

Results: Ten areas of focus were identified. Delphi participants included 15 dermatologists, 8 nurses, and 6 nonhealth care caregivers. Consensus was established on 103/119 neonatal statements and 105/122 postneonatal statements; no statements were rejected. Most recommendations applied to both age groups.

Limitations: Recommendations may require adjustment based on individual patient's clinical context.

Conclusion: Using the Delphi method, a consensus-derived resource for hospital-based health care professionals who manage patients with EB has been developed to improve the quality of inpatient care.

Keywords: Delphi; epidermolysis bullosa; general dermatology; guidelines; hospital management; medical dermatology.