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The Severity of Illness Score for Toxic Epidermal Necrolysis (SCORTEN score) calculator assesses the risk of mortality in patients by evaluating seven clinical parameters, each represented by a boolean input. Each true parameter contributes 1 point to the total score. The inputs assessed are:

- Age > 40 years
- Presence of malignancy
- Tachycardia > 120/min
- > 10% initial epidermal detachment
- Serum urea > 10 mmol/L
- Serum glucose > 14 mmol/L
- Serum bicarbonate < 20 mmol/L

The calculator sums the points for true conditions to yield a total score between 0 and 7. The interpretation of the score relates to the risk of mortality, with different scores indicating the following risks:

| Score | Interpretation                       |
|-------|--------------------------------------|
| 0     | Risk of mortality not precisely defined |
| 1     | Risk of mortality is 3.88%           |
| 2     | Risk of mortality is 12.20%          |
| 3     | Risk of mortality is 32.37%          |
| 4     | Risk of mortality is 62.25%          |
| 5     | Risk of mortality is 85.03%          |
| 6     | Risk of mortality is 95.14%          |
| 7     | Risk of mortality is 98.54%          |

The SCORTEN score, also known as the Severity of Illness Score for Toxic Epidermal Necrolysis, is a clinical tool used to predict mortality in patients diagnosed with Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). These are severe skin reactions, often to medication, that can be life-threatening. 

The SCORTEN score is calculated based on seven clinical and laboratory parameters, each contributing one point to the total score. These parameters include age, malignancy, heart rate, initial body surface area of epidermal detachment, serum urea, serum glucose, and bicarbonate levels. 

The higher the SCORTEN score, the higher the predicted mortality rate. This score is particularly useful in the early stages of disease to guide treatment decisions and inform discussions about prognosis with patients and their families. 

There are no specific exclusion criteria for the use of the SCORTEN score, but it should be noted that it is most accurate when applied within the first 24-48 hours of hospital admission for SJS/TEN. It may not be as accurate in predicting outcomes for patients with less severe forms of the disease or for those with other severe concurrent illnesses.

Severity of Illness Score for Toxic Epidermal Necrolysis (SCORTEN score)

The Algorithm of Drug Causality for Epidermal Necrolysis (ALDEN score) is a tool designed to evaluate the involvement of drugs in triggering Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). By assessing several key criteria related to drug intake, history, and associated risks, the calculator provides insights into the likelihood of a drug causing these severe skin reactions.

To determine the ALDEN score, consider the following inputs:

- Delay from initial drug component intake to the onset of reaction: 
  - Ranges from "Drug started on or after the index day" to "> 56 days." Scores are allocated based on the timing and previous exposure, typically falling between 1 and 3.

- Drug presence in the body on the index day:
  - Evaluates whether the drug was still active or if it was stopped prior to the reaction occurring. This ranges from 0 (if the drug was continued or stopped shortly before) to 3 (if discontinued well in advance with no interacting conditions).

- Prechallenge or rechallenge history:
  - Considers previous exposures to the same or similar drugs and the presence of SJS/TEN reactions. Scores range from 0 to 4, reflecting the severity and directness of prior reactions.

- Dechallenge response:
  - Observes outcomes after ceasing or continuing the drug. A score of 0 is given if the drug was stopped or unknown, and 2 if continued without adverse effects.

- Drug risk level:
  - Assesses the risks associated with the drug based on existing epidemiological studies. Scores vary from 0 for low-risk or new drugs to 3 for high-risk drugs identified in previous studies.

- Other potential causes: 
  - Acknowledges any other probable drugs responsible for the reaction, scoring 1 if applicable.

By summing these scores, the tool provides a total score ranging from 2 to 16. This score is then interpreted to gauge the likelihood of the drug causing SJS/TEN:

| Score | Interpretation    |
|-------|-------------------|
| ≤ -1  | Very unlikely     |
| 0     | Unlikely          |
| 1     | Unlikely          |
| 2     | Possible          |
| 3     | Possible          |
| 4     | Probable          |
| 5     | Probable          |
| 6     | Very probable     |

The ALDEN score thus aids in discerning the probability that a specific drug is responsible for the adverse skin reaction, providing valuable guidance for clinicians in evaluating patient cases.

The ALDEN score, or Algorithm of Drug Causality for Epidermal Necrolysis, is a clinical calculator used in the field of dermatology. It is specifically designed for patients who have developed severe skin reactions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which are often drug-induced. The ALDEN score helps clinicians to identify the likelihood that a specific drug has caused the skin reaction in a patient.

The clinical utility of the ALDEN score is to guide clinicians in identifying the causative drug in cases of SJS and TEN, which is crucial for preventing further exposure to the drug and managing the patient's condition. It takes into account factors such as the timing of drug exposure, the latency period, and the drug's inherent likelihood of causing such reactions.

There are no specific exclusion criteria for the use of the ALDEN score. However, it should be noted that the score is less reliable in cases where the patient has been exposed to multiple drugs, or when the onset of the skin reaction is not clear. It is also less useful in cases where the reaction is not drug-induced.

Algorithm of Drug Causality for Epidermal Necrolysis (ALDEN score)

The ABCD-10 Mortality Prediction Model is a tool designed to assess the mortality risk for patients suffering from Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis. It evaluates specific health indicators and attributes a score to each, which is then summed to estimate the risk of mortality.

Five key patient conditions are assessed:

- **Age**: Patients age 50 or older receive a score of 1, while those under 50 score 0.
- **Epidermal Detachment**: If the detachment affects more than 10% of the body surface, 1 point is given, otherwise, it's 0.
- **Serum Bicarbonate Level**: A level below 20 mmol/L scores 1 point, whereas 20 mmol/L or more scores 0.
- **Active Cancer Presence**: If the patient has active cancer, they are assigned 2 points; if not, they score 0.
- **Dialysis Before Presentation**: Patients who have undergone dialysis receive 3 points, while those who haven't score 0.

The scores from these evaluations are summed to obtain a total score, which can range from 0 to 8. This total score translates into different risk interpretations, detailing the likelihood of mortality:

- Score of 0 corresponds to a 2.3% risk of mortality.
- Score of 1 indicates a 5.4% risk.
- Score of 2 reflects a 12.3% risk.
- Score of 3 denotes a 25.5% risk.
- Score of 4 suggests a 45.7% risk.
- Score of 5 represents a 67.4% risk.
- For scores of 6 or higher, the mortality risk is 83.6%.

These interpretations allow healthcare professionals to gauge the severity of the patient's condition and potentially guide their clinical decisions regarding care and treatment options for those facing Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis.

The ABCD-10 Mortality Prediction Model for Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is a clinical calculator used to predict the mortality risk in patients diagnosed with Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis. These are severe skin reactions often triggered by medications, with TEN being more severe than SJS. 

The ABCD-10 model applies specifically to patients diagnosed with SJS/TEN and is used to guide clinical decision-making and patient counseling by providing an estimate of the patient's risk of mortality. 

The calculator uses four variables: Age (A), Bicarbonate level (B), Cancer (C), and Dialysis (D), with the '10' referring to the 10-point scale used. Each variable contributes to the total score, which correlates with the patient's mortality risk.

There are no specific exclusion criteria for the use of the ABCD-10 model, but it should be noted that it may not be as accurate in patients with atypical presentations of SJS/TEN or in those with other severe concurrent illnesses that could independently affect mortality.

Stevens-Johnson syndrome

Guidelines

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