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Dermatological conditions in intensive care: a secondary analysis of the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme database.

George SM, Harrison DA, Welch CA, Nolan KM, Friedmann PS - Crit Care (2008)

Bottom Line: Overall mortality was 28.1% in the ICU and 40.0% in hospital.We have identified patients who not only require intensive care, but also dermatological care.Such patients have high mortality rates and long ICU stays within the spectrum of the UK ICU population, similar to other acute medical conditions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Clinical Teaching Fellow in Specialties (Dermatology), St Helier Hospital, Wrythe Lane, Carshalton, Surrey SM5 1AA, UK. susannahgeorge@hotmail.com

ABSTRACT

Introduction: Dermatology is usually thought of as an outpatient specialty with low mortality, however some skin conditions require intensive care. These conditions are relatively rare and hence are best studied using clinical databases or disease registries. We interrogated a large, high-quality clinical database from a national audit of adult intensive care units (ICUs), with the aim of identifying and characterising patients with dermatological conditions requiring admission to ICU.

Methods: Data were extracted for 476,224 admissions to 178 ICUs in England, Wales and Northern Ireland participating in the Case Mix Programme over the time period December 1995 to September 2006. We identified admissions with dermatological conditions from the primary and secondary reasons for admission to ICU.

Results: A total of 2,245 dermatological admissions were identified. Conditions included infectious conditions (e.g. cutaneous cellulitis, necrotising fasciitis), dermatological malignancies, and acute skin failure (e.g. toxic epidermal necrolysis, Stevens-Johnson syndrome and autoimmune blistering diseases). These represent 0.47% of all ICU admissions, or approximately 2.1 dermatological admissions per ICU per year. Overall mortality was 28.1% in the ICU and 40.0% in hospital. Length of stay in intensive care was longest for those with acute skin failure (median 4.7 days for ICU survivors and 5.1 days for ICU non-survivors).

Conclusion: We have identified patients who not only require intensive care, but also dermatological care. Such patients have high mortality rates and long ICU stays within the spectrum of the UK ICU population, similar to other acute medical conditions. This highlights the importance of skin failure as a distinct entity comparable to other organ system failures.

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Ultimate hospital mortality by SCORTEN for admissions with toxic epidermal necrolysis and related conditions (n = 145).
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Figure 1: Ultimate hospital mortality by SCORTEN for admissions with toxic epidermal necrolysis and related conditions (n = 145).

Mentions: For admissions with TEN, SJS and erythema multiforme (n = 145), mortality increased steeply with SCORTEN (Figure 1), rising from around 20% for scores of 0–2 to over 70% for scores of 4 or more. The area under the ROC curve for SCORTEN was 0.762 (95% confidence interval 0.685–0.838) (Figure 2). This compared with values of 0.737 (0.655–0.819) for the APACHE II score (in 137 eligible patients), and 0.795 (0.722–0.867) for the ICNARC model, suggesting that the ICNARC model was best for discriminating between survivors and non-survivors in this patient group. However, with relatively small numbers, none of the differences in ROC curves were statistically significant (SCORTEN versus APACHE II, Chi-squared = 0.14, p = 0.73; SCORTEN versus ICNARC model, Chi-squared = 1.08, p = 0.30; ICNARC model versus APACHE II, Chi-squared = 1.52, p = 0.22).


Dermatological conditions in intensive care: a secondary analysis of the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme database.

George SM, Harrison DA, Welch CA, Nolan KM, Friedmann PS - Crit Care (2008)

Ultimate hospital mortality by SCORTEN for admissions with toxic epidermal necrolysis and related conditions (n = 145).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2607109&req=5

Figure 1: Ultimate hospital mortality by SCORTEN for admissions with toxic epidermal necrolysis and related conditions (n = 145).
Mentions: For admissions with TEN, SJS and erythema multiforme (n = 145), mortality increased steeply with SCORTEN (Figure 1), rising from around 20% for scores of 0–2 to over 70% for scores of 4 or more. The area under the ROC curve for SCORTEN was 0.762 (95% confidence interval 0.685–0.838) (Figure 2). This compared with values of 0.737 (0.655–0.819) for the APACHE II score (in 137 eligible patients), and 0.795 (0.722–0.867) for the ICNARC model, suggesting that the ICNARC model was best for discriminating between survivors and non-survivors in this patient group. However, with relatively small numbers, none of the differences in ROC curves were statistically significant (SCORTEN versus APACHE II, Chi-squared = 0.14, p = 0.73; SCORTEN versus ICNARC model, Chi-squared = 1.08, p = 0.30; ICNARC model versus APACHE II, Chi-squared = 1.52, p = 0.22).

Bottom Line: Overall mortality was 28.1% in the ICU and 40.0% in hospital.We have identified patients who not only require intensive care, but also dermatological care.Such patients have high mortality rates and long ICU stays within the spectrum of the UK ICU population, similar to other acute medical conditions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Clinical Teaching Fellow in Specialties (Dermatology), St Helier Hospital, Wrythe Lane, Carshalton, Surrey SM5 1AA, UK. susannahgeorge@hotmail.com

ABSTRACT

Introduction: Dermatology is usually thought of as an outpatient specialty with low mortality, however some skin conditions require intensive care. These conditions are relatively rare and hence are best studied using clinical databases or disease registries. We interrogated a large, high-quality clinical database from a national audit of adult intensive care units (ICUs), with the aim of identifying and characterising patients with dermatological conditions requiring admission to ICU.

Methods: Data were extracted for 476,224 admissions to 178 ICUs in England, Wales and Northern Ireland participating in the Case Mix Programme over the time period December 1995 to September 2006. We identified admissions with dermatological conditions from the primary and secondary reasons for admission to ICU.

Results: A total of 2,245 dermatological admissions were identified. Conditions included infectious conditions (e.g. cutaneous cellulitis, necrotising fasciitis), dermatological malignancies, and acute skin failure (e.g. toxic epidermal necrolysis, Stevens-Johnson syndrome and autoimmune blistering diseases). These represent 0.47% of all ICU admissions, or approximately 2.1 dermatological admissions per ICU per year. Overall mortality was 28.1% in the ICU and 40.0% in hospital. Length of stay in intensive care was longest for those with acute skin failure (median 4.7 days for ICU survivors and 5.1 days for ICU non-survivors).

Conclusion: We have identified patients who not only require intensive care, but also dermatological care. Such patients have high mortality rates and long ICU stays within the spectrum of the UK ICU population, similar to other acute medical conditions. This highlights the importance of skin failure as a distinct entity comparable to other organ system failures.

Show MeSH
Related in: MedlinePlus