Readmisión en SJS y Lyell

Published in Dermatology

Journal Scan / Research · October 08, 2019

Predictors of 30-Day Readmission in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• In this retrospective study based on analysis of the National Readmissions Database, 8837 index admissions for Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) were identified. Of these, 910 (10.3%) patients were readmitted within 30 days. The most common readmission diagnoses were systemic infection including sepsis and pneumonia (22%), SJS/TEN (20.6%), and cutaneous infection (9.1%). Using multivariate logistic regression, the authors found that age 45 to 64 years (P<.001), non-commercial insurance (P<.001), and admission to a non-metropolitan (P<.001) or to a metropolitan non-teaching (P=.04) hospital were associated with higher rates of readmission. Secondary diagnoses, including HIV/AIDS, collagen vascular disease, diabetes, congestive heart failure, and neurologic disorders, were also associated with higher rates of readmission.

• These findings demonstrate that 30- day readmission after SJS/TEN hospitalization is common. Efforts to identify patients at an increased risk for readmission, such as those with chronic medical conditions, may improve these outcomes. Inpatient dermatology services may aid in this process.

– Margaret Hammond, MD

Abstract

BACKGROUND

The predictors of readmission in Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) have not been characterized.

OBJECTIVE

To determine the variables predictive of 30-day readmission after SJS/TEN hospitalization.

METHODS

We performed a cross-sectional study of the 2010-2014 Nationwide Readmissions Database (NRD). Bivariate and multivariable logistic regression was used to evaluate associations of patient demographics, comorbidities, and hospital characteristics with readmission. Aggregate and per-readmission costs were calculated.

RESULTS

A total of 8,837 index admissions with SJS/TEN were reported. A total of 910 (10.3%) were readmitted, with diagnoses including systemic infection (22.0%), SJS/TEN (20.6%), and cutaneous infection (9.1%). Associated characteristics included age 45-64 years (Odds Ratio [OR] 1.88, 95% confidence interval [CI] 1.43-2.49), Medicaid insurance (OR 1.83, CI 1.48-2.27) and non-metropolitan hospital admission (OR 1.67, CI 1.31-2.13). Associated comorbidities included HIV/AIDS (OR 2.48, CI 1.63-3.75), collagen vascular disease (OR 2.38, CI 1.88-3.00), and metastatic cancer (OR 2.16, CI 1.35-3.46). The median per-readmission cost was $10,019 (interquartile range $4,788 - $16,485).

LIMITATIONS

The NRD lacks the ability to track the same patient across calendar years. The diagnostic code lacks specificity for hospitalizations < 3 days.

CONCLUSIONS

Thirty-day readmissions after SJS/TEN hospitalizations are common. Dedicated efforts to identify at-risk patients may improve peri-discharge continuity.

Journal of the American Academy of Dermatology

Predictors of 30-Day Readmission in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Retrospective, Cross-Sectional Database Study

J Am Acad Dermatol 2019 Sep 19;[EPub Ahead of Print], AK Guzman, M Zhang, SG Kwatra, BH Kaffenberger 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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