Poster Presentation Australasian Society for Dermatology Research 2022 Annual Scientific Meeting

Metropolitan and non-metropolitan mortality outcome comparison for a contemporary cohort of SJS/TEN patients. (#20)

Miki Wada 1 , Christopher Y Chew 1 2 , Adithya Shastry 1 3 , Dale Jobson 1 4 , Zhengyang Liu 5 6 , Zhao Feng Liu 7 , Ella Rose Ryan 7 , Nidhin Sunil Kuruvilla 7 , Sarah Smithson 1 , Michelle Goh 1 , Douglas Gin 1
  1. Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia
  2. Department of Medicine, Monash University, Melbourne, Victoria, Australia
  3. College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
  4. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  5. Department of Dermatology, Royal Melbourne Hospital, Parkville, Victoria, Australia
  6. Department of Medicine, University of Melbourne, Parkville, Melbourne, Australia
  7. Monash School of Medicine, Monash University, Clayton, Victoria, Australia

Background: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are dermatological emergencies characterised by epidermal desquamation and are associated with significant mortality.

 

Hypothesis: We hypothesise that non-metropolitan residents with SJS, TEN or SJS/TEN overlap will have a higher 90-day all-cause mortality rate than metropolitan residents with SJS, TEN or SJS/TEN overlap.

 

Methodology: Patients treated for SJS, TEN or SJS/TEN overlap syndrome at Alfred Hospital, a quaternary referral hospital with a multidisciplinary management team, over an 8 year period between 1/7/2013 to 30/6/2021 were included. A comparison of 90-day all-cause mortality was performed of patients diagnosed with SJS, TEN or SJS/TEN overlap. Metropolitan and non-metropolitan status was determined using both the Modified Monash Model (MMM) for rurality and radial distance in kilometres from Alfred Hospital.

 

Results: A total of 83 patients were diagnosed with SJS (15, 18.1%), TEN (42, 50.6%) or SJS/TEN (26, 31.3%). 90-day mortality was 18.1% (15/83). Mortality amongst patients from MMM1 (metropolitan) postcodes compared to MMM2-7 (rural and regional) postcodes was 20.3% (14/69) and 7.1% (1/14) respectively (OR 3.3091, p=0.2679). Distance between postcode of residence to Alfred Hospital had no impact on mortality, postcode < 50km distance 20% (13/65) and >50 km 11.1% (2/18) (OR 2.25, p=0.3151). Despite a low mortality amongst patients presenting to Alfred Hospital (6.67%, 1/15 Alfred vs 20/6%, 14/58 non-Alfred), the result was not significant (OR 0.2755, p=0.2316).

 

Conclusion: There is no statistically significant difference in 90-day mortality between patients with SJS/TEN living in metropolitan and non-metropolitan regions using both MMM and distance above or below 50 kilometres from a quaternary hospital.