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Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: an international, multidisciplinary Delphi-based consensus

Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: an international, multidisciplinary Delphi-based consensus
Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: an international, multidisciplinary Delphi-based consensus

Background: Supportive care is the cornerstone of management of adult and paediatric Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking. Objectives: Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN. Methods: Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method. Results: Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements. Conclusions: We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.

0007-0963
616-626
Ardern-Jones, Michael
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Bruggen, M.
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Le, S.T.
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Walsh, S.
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Toussi, A.
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de Prost, N.
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Ranki, A.
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Didona, B.
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Colin, A.
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Horvath, B.
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Brezinova, E.
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Milpied, B.
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Moss, C.
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Bodemer, C.
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Meyersburg, D.
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Salavastru, C.
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Tiplica, G.S.
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Howard, E.
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Bequignon, E.
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Bouwes Bavinck, J.N.
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Newman, J.
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Gueudry, J.
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Nageli, M.
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Zaghbib, K.
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Pallesen, K.
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Ardern-Jones, Michael
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Bruggen, M.
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Le, S.T.
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Walsh, S.
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Toussi, A.
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de Prost, N.
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Ranki, A.
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Didona, B.
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Colin, A.
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Horvath, B.
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Brezinova, E.
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Milpied, B.
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Moss, C.
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Bodemer, C.
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Meyersburg, D.
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Salavastru, C.
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Tiplica, G.S.
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Howard, E.
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Bequignon, E.
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Bouwes Bavinck, J.N.
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Newman, J.
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Gueudry, J.
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Nageli, M.
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Zaghbib, K.
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Pallesen, K.
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Ardern-Jones, Michael, Bruggen, M., Le, S.T., Walsh, S., Toussi, A., de Prost, N., Ranki, A., Didona, B., Colin, A., Horvath, B., Brezinova, E., Milpied, B., Moss, C., Bodemer, C., Meyersburg, D., Salavastru, C., Tiplica, G.S., Howard, E., Bequignon, E., Bouwes Bavinck, J.N., Newman, J., Gueudry, J., Nageli, M., Zaghbib, K. and Pallesen, K. (2021) Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: an international, multidisciplinary Delphi-based consensus. British Journal of Dermatology, 185 (3), 616-626. (doi:10.1111/bjd.19893).

Record type: Article

Abstract

Background: Supportive care is the cornerstone of management of adult and paediatric Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking. Objectives: Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN. Methods: Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method. Results: Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements. Conclusions: We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.

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Published date: 3 March 2021

Identifiers

Local EPrints ID: 449558
URI: http://eprints.soton.ac.uk/id/eprint/449558
ISSN: 0007-0963
PURE UUID: ad109dd0-c04b-418f-85f4-088440f08b79

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Date deposited: 08 Jun 2021 16:30
Last modified: 25 Nov 2021 18:45

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Contributors

Author: M. Bruggen
Author: S.T. Le
Author: S. Walsh
Author: A. Toussi
Author: N. de Prost
Author: A. Ranki
Author: B. Didona
Author: A. Colin
Author: B. Horvath
Author: E. Brezinova
Author: B. Milpied
Author: C. Moss
Author: C. Bodemer
Author: D. Meyersburg
Author: C. Salavastru
Author: G.S. Tiplica
Author: E. Howard
Author: E. Bequignon
Author: J.N. Bouwes Bavinck
Author: J. Newman
Author: J. Gueudry
Author: M. Nageli
Author: K. Zaghbib
Author: K. Pallesen

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