Development of Multidisciplinary Consensus‐Informed Guidance for the Management of Paediatric Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis Among Clinicians From Australasian Tertiary Referral Hospitals
Year: 2026
Type: article
Abstract: BACKGROUND: Paediatric Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, severe mucocutaneous reaction requiring coordinated multidisciplinary care. Existing guidelines provide evidence-based recommendations, but implementation across tertiary paediatric hospitals requires practical consensus on local resources. AIM: To develop and evaluate multidisciplinary consensus-informed practical clinical guidance for assessment and management of paediatric SJS/TEN among clinicians from Australasian tertiary referral hospitals. METHODS: A draft guidance document was developed after review of SJS/TEN guidelines, systematic reviews and other relevant literature. Clinicians from one tertiary paediatric centre (Group A) and other Australian and New Zealand tertiary centres (Group B) completed a 130-item questionnaire. Continuous items were scored on a 1-9 Likert scale. Categorical items addressed referral urgency and whether investigations should be routine, reasonable but not routine, or not ordered. Quantitative responses and free-text comments informed revision. RESULTS: Twenty-two multidisciplinary clinicians from the internal centre and nine clinicians from eight external centres participated. Agreement was high for history, examination, supportive care, multidisciplinary involvement, discharge planning and follow-up. Uncertainty remained regarding fluid requirements compared with burns patients, the scope of initial investigations and systemic immunomodulatory therapy. The guidance was revised to emphasise individualised fluid management, directed differential diagnosis and testing, and case-by-case systemic therapy. CONCLUSIONS: This practical multidisciplinary consensus-informed guidance supports paediatric SJS/TEN care in Australasian tertiary referral hospitals. Its contribution is the quantified consultative process and identification of consistent, variable and uncertain practice. It complements, rather than replaces, existing guidelines.
DOI: 10.1111/jpc.70435
Authors: Patrick David Mahar, Thomas Lee, David Orchard, Amy Gray, Laura Scardamaglia, Susan Robertson, Monique Bertinetti, Warwick Teague, Danielle Nizzero, Claire Grills, Ryan Toholka, Danni Bao, Julian Kelly, Joanne Grindlay, Thomas Rozen, Mark Oliver, Nicole Alexander, Ashan Fernando, Anu Matthew, Kiri Chan, Sonia R. Grover, Emma McDonald, Li‐Chuen Wong, Marius Rademaker, Diana Purvis, Katherine Dear, Stephanie Weston, Vanessa Morgan, Anne Halbert, Orli Wargon, Gayle Fischer, Erin Mewton, Emma King
Institutions: Royal Children's Hospital, The University of Melbourne, Skin Health Institute, The Royal Melbourne Hospital, Western Health, Murdoch Children's Research Institute, Monash Health, Monash University, Children's Hospital at Westmead, Waikato Hospital, Clinical Trials New Zealand, Starship Children's Health, Princess Margaret Hospital for Children, Perth Children's Hospital, UNSW Sydney, Sydney Children's Hospital, The University of Sydney, Royal North Shore Hospital
Language: English
Subfield: Pharmacology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,150
Funder: University of Melbourne
OpenAlex ID: W7163083137