Dr Harmeet Bhullar1, Dr Ar Kar Aung1,2, Dr Heather Cleland1,2, Dr Josh Ihle1, Ms Linda Graudins1, Dr Bing Teh1
1Alfred Health, Melbourne, Australia, 2Monash University, School of Medicine, Clayton, Australia
Background:Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TENs) are life-threatening hypersensitivity conditions associated with epidermal detachment and mucositis. There are currently no large studies to support the routine use of functional nasendoscopy (FNE) and the predictive factors for intubation in these patients.
Objectives:To determine key indicators for intubation in the SJS/TENS patient cohort.
To determine FNE findings which indicate need for early intubation.
Methods: A retrospective chart review of 37 patients with biopsy proven SJS/TENS admitted at Alfred Health from 2010 to 2017.
Results:Seventeen (46%) patients underwent intubation while 3 (8%) had tracheostomies. Intubated patients were more likely to be diagnosed with TENS (94%) vs non-intubated (60%) patients (p <0.05). A SCORe of TEN (SCORTEN) of 2 on day 3 was more likely in the intubated (IQR 2-3.5) vs non-intubated (IQR 1-2) group (p<0.05). An increase in TBSA (%) day 1-3 was higher in the intubated [10 (IQR 0-22.5)] vs non-intubated [0 (IQR 0-4.5)] (p<0.05) group. Patients in our cohort were intubated to facilitate theatre and dressing management (56%), respiratory distress (33%) and drop in Glasgow Coma Scale (13%). FNE was performed on 29 patients; 14 were intubated. FNE findings were not predictive of intubation in our cohort.
Conclusion: Nearly half of all patients with SJS/ TENS require airway intervention. Diagnosis of TENS, SCORTEN of 2 (day 3) and progression of TBSA of at least 10% (day 1 to 3) are associated with the need for intubation. FNE should be prioritised for patients with high risk factors.
Dr Harmeet Bhullar holds a Doctor of Medicine from the University of Melbourne and a Bachelor of Pharmacy from Monash University. She is currently a surgical resident at Alfred Health. She has travelled extensively, and is an avid reader. She is keen to pursue a career in surgery.