Children's Motrin signs of Side Effects


Stevens Johnson Syndrome Children's Motrin Attorney

Children's Motrin medicine and Stevens Johnson Syndrome side effect, if you don't stop the medicine at the first signs of a reaction the Stevens Johnson Syndrome disease could run its course.

The first signs maybe a red face and a cloudy liquid in your child's eyes.

Reactions Weekly: 28 April 2012 - Volume - Issue 1399 - p 26

Case report Phenytoin: Toxic epidermal necrolysis in an elderly patient: case report


A systematic review of validated methods for identifying erythema multiforme major/minor/not otherwise specified, Stevens–Johnson Syndrome, or toxic epidermal necrolysis using administrative and claims data Gary Schneider*, Sumesh Kachroo, Natalie Jones, Sheila Crean, Philip Rotella, Ruzan Avetisyan, Matthew W. Reynolds

Article first published online: 19 JAN 2012

DOI: 10.1002/pds.2331

We identified four reports (albeit three unique studies) fulfilling all inclusion criteria,[7, 9, 10, 11] and another two with algorithms but with no validation.[12, 14]

All studies showed consistency in defining EM and related conditions using International Classification of Diseases-Adapted, Eighth Modification (ICDA-8) code 695.1[7] or International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 695.1.[9, 10, 11, 12, 14]

Details of the four studies with algorithm validation are presented in Table 1.

Table 1. Erythema multiforme coding algorithms and positive predictive values (PPV) of citations with validation Citation Study population and study period Description of outcome studied

Algorithm Validation/adjudication procedure and operational definition Validation statistics EM, erythema multiforme; HMO, Health Maintenance Organization; SJS, Stevens–Johnson syndrome; SSSS, staphylococcus scalded-skin syndrome; TEN, toxic epidermal necrolysis; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification. Chan et al. 1990[7]

HMO administrative and claims data from Group Health Cooperative (GHC) of Puget Sound, Seattle, WA, with hospital discharge diagnosis of EM (n = 61), 1972–1986. Incidence of EM, SJS, and TEN requiring hospitalization. Diagnosis of ICDA-8: 695.1 (erythema multiforme).

ICDA-8 695.1 should, in principle, include all hospitalized cases of EM, SJS, and TEN.

Review of discharge summaries, hospital records, and outpatient charts via criteria for diagnosis as described in paper. PPV (without SSSS) = 59.6%.

Strom 2001[9] Computerized On-Line Medicaid Pharmaceutical Analysis and Surveillance System (COMPASS), a computerized database consisting of Medicaid administrative and claims patients from the states of Michigan, Minnesota, Florida, Missouri, and Nebraska with an inpatient diagnosis of EM and medical charts available for review (N = 167), 1768–1985.

Assessed the validity of the ICD-9-CM 695.1 code to ascertain SJS. ICD-9-CM 695.1 for SJS and EM. Medical record review. PPV (without SSSS) = 54.0%.

Strom et al. 1991[10, 11] COMPASS, with an inpatient diagnosis of EM and medical charts available for review (N = 128), 1768–1984. Determined the incidence of SJS. ICD-9-CM 695.1 for SJS and EM. Medical record review. PPV (without SSSS) = 53.7%.

Of the 273 potential cases from which the medical records were obtained, majority of the cases were from Michigan (67%) and aged 0–19 years (60.4%); males comprised 39%, and 55% resided in urban areas.[11]

Through September 2008, ICD-9-CM code 695.1 incorporated the EM conditions of erythema iris and herpes iris, SJS, TEN/Lyell's syndrome, and staphylococcus scalded-skin syndrome (SSSS).[16]

Because this code is multi-diagnostic, reporting a positive predictive value (PPV) statistic for each unique disease under its umbrella would be deceptive. We therefore, in Table 1, report the PPV of the combination of diseases of study interest: EM, SJS, and TEN. SSSS, which was responsible for 15%–16% of this code, was excluded from these PPV calculations because it is no longer incorporated into ICD-9-CM code 695.1.

After excluding SSSS, between 53% and 60% of ICD-9-CM code 695.1 reports were validated cases of EM, SJS, or TEN.

DISCUSSION The literature review identified only ICD-9-CM code 695.1 as a coding algorithm used for EM major/minor/not otherwise specified, SJS, or TEN. Chan et al.[7] used ICDA-8 code 695.1, and Strom[9] and Strom et al.[10, 11] used ICD-9-CM code 695.1.

These studies consistently found that slightly more than half of patients with this diagnostic code had EM, SJS, or TEN. Other skin diseases and truly misclassified diagnoses contributed approximately 35%–40% and 6% to the total, respectively, illustrating that clinical experts frequently disagree with the discharge diagnosis of EM/SJS/TEN (ICD-9-CM 695.1).

Such disagreement may also be the result of the inherent difficulties in validating a diagnostic code based on a review of source documents. Increased understanding of the diseases covered by ICD-9-CM code 695.1 has occurred since the publication of the articles included in this review.

For example, TEN and SJS differ in etiology from SSSS: medications are a common cause of TEN/SJS, whereas staphylococcal infection is typically the causative agent for SSSS.[17] This increased knowledge led to SSSS being recoded to a separate ICD-9-CM code as well as the inclusion of a fifth digit to ICD-9-CM code 695.1. This fifth digit provides specific codes for each disease, excluding SSSS, previously contained in the four-digit, multi-diagnostic code (ICD-9-CM code 695.1).

These updates were effective as of October 2008. In an attempt to mirror the current diagnostic coding of EM, SJS, and TEN, we excluded SSSS from the PPV calculations. Despite this decision, it is likely that we are underestimating the true PPV because we assumed that all other common misdiagnoses would remain within ICD-9-CM code 695.1; in reality, a proportion of these would likely be transferred to the new code representing SSSS.

CONCLUSIONS The studies identified in our search showed consistency in defining EM and related conditions. We found that clinical experts frequently disagreed with the discharge diagnoses of EM, SJS, and TEN.

Our search, however, revealed limited literature that provided validated algorithms and validation estimates.

Furthermore, the most recent data identified in our search were 25 years old and therefore did not incorporate the October 2008 diagnostic coding changes.

Because the identified literature supplying both algorithms and validation estimates is dated, the Mini-Sentinel goal of refining safety signals focused on these specific diseases is compromised. Updated research should be conducted on development and validation of coding algorithms for EM, SJS, and TEN.