Why use it

Best validated mortality predictor for SJS/TEN. Guides ICU vs. ward disposition. Facilitates prognosis discussions with patients/families. Supports early transfer to specialized burn/dermatology centers.

About

SCORTEN predicts mortality in patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) based on 7 clinical and laboratory variables assessed within the first 24 hours of admission. It guides the level of care and treatment intensity.

When to use

Confirmed or suspected SJS/TEN at admission
Within first 24 hours (day 1) and again at day 3
Guiding level of care and treatment intensity

Formula

One point each for: 1. Age ≥ 40 years 2. Cancer/malignancy 3. Heart rate ≥ 120 bpm 4. Initial BSA detachment ≥ 10% 5. Serum urea > 28 mg/dL (BUN > 28) 6. Glucose > 252 mg/dL (14 mmol/L) 7. Bicarbonate < 20 mEq/L

Pearls & pitfalls

Calculate at admission (day 1) and repeat at day 3 — day 3 SCORTEN is more predictive.
Immediate discontinuation of the causative drug is the most important intervention.
BSA detachment ≥ 10% scores +1; this is the TEN threshold.
SCORTEN was specifically validated for SJS/TEN — not for other blistering diseases.
Treatment is primarily supportive (wound care, fluids, pain, infection prevention).
IVIG and cyclosporine may be considered but evidence is limited.

Next steps

SCORTEN 0-1: ~3-12% mortality — close monitoring, ward may be sufficient. SCORTEN 2: ~12% — consider ICU. SCORTEN 3: ~35% — ICU admission, burn center transfer. SCORTEN ≥ 4: ~58-90% — ICU/burn center essential; aggressive supportive care.

Evidence

Derived by Bastuji-Garin et al. (J Invest Dermatol, 2000) in 165 patients. Validated in multiple cohorts. SCORTEN ≥ 5 associated with >90% mortality in original study.

References

Bastuji-Garin S et al. SCORTEN: a severity-of-illness score for toxic epidermal necrolysis. J Invest Dermatol. 2000;115(2):149-153. — link

SCORTEN

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