SCORTEN: Does it need modification?

Background: Toxic epidermal necrolysis (TEN) is a drug induced acute life threatening condition with mortality ranging from about 15 to 60%. A ′severity of illness′ score termed as SCORTEN has been developed to predict mortality in TEN cases at the time of admission. It is calculated by giving one point for each of predetermined seven variables, evaluated during first 24 hours of admission. Total score ranging from 1-7 predicts a probability of mortality from 0.03 to 0.90. Aim: A prospective study was conducted to analyze efficacy of ′SCORTEN′ in TEN cases to predict mortality during their management. Methods: All cases of TEN reporting for management to the hospital were assessed using ′SCORTEN′ on day one and day five to predict probable mortality, this data was then compared with ultimate outcome. Results: During the study period, we treated 10 cases of TEN, all induced by drugs, patient′s age ranging from 03 to 70 years and body surface area (BSA) involvement from 10 to 95%. Three cases succumbed to death. These cases were analyzed with SCORTEN to predict probability of mortality at the time of admission and day five. We encountered some variations from the original study. It was observed that if patients are analyzed with SCORTEN on a daily/alternate day basis, it will serve as a better predictor of mortality. Conclusion: Body surface area (BSA) involvement and age probably need more weightage in calculations. Besides malignancy, tuberculosis and pre-existing diabetes also need to be included while predicting mortality.